Provider Demographics
NPI:1790783777
Name:KUWABARA, IRIS Y (OD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:Y
Last Name:KUWABARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:STE. 260
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-625-5144
Mailing Address - Fax:808-625-8891
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:STE. 260
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-625-5144
Practice Address - Fax:808-625-8891
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI266152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIU43475Medicare UPIN
HIH0000PGBMKMedicare PIN