Provider Demographics
NPI:1790792760
Name:KAWAMURA, KEITH TSUGIO (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:TSUGIO
Last Name:KAWAMURA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:302 CALIFORNIA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-597-1133
Mailing Address - Fax:808-596-0251
Practice Address - Street 1:1003 PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1927
Practice Address - Country:US
Practice Address - Phone:808-597-1133
Practice Address - Fax:808-596-0251
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
949616420OtherUNITED HEALTH ALLIANCE
HI245480OtherHMSA
HIH56312Medicare PIN