Provider Demographics
NPI:1821064254
Name:ICHIMURA, PATRICIA K (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:ICHIMURA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:K
Other - Last Name:ICHIMURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-625-7451
Mailing Address - Fax:808-625-5574
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-625-7451
Practice Address - Fax:808-625-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI116762001Medicare ID - Type Unspecified
HIU10493Medicare UPIN
HI50316Medicare ID - Type Unspecified
HICP968AMedicare PIN