Provider Demographics
NPI:1851780621
Name:KAWAMURA EYE CARE, LLC
Entity Type:Organization
Organization Name:KAWAMURA EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAWAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-497-2589
Mailing Address - Street 1:94-761 MEAHALE ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-621-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIU99038Medicare UPIN