Provider Demographics
NPI:1861471674
Name:ENDO, EDWIN Y (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:Y
Last Name:ENDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1247 KAAHUMANU ST
Mailing Address - Street 2:STE 105
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5300
Mailing Address - Country:US
Mailing Address - Phone:808-487-5500
Mailing Address - Fax:808-486-2694
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:STE 105
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-487-5500
Practice Address - Fax:808-486-2694
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000PCBQFOtherMEDICARE INDIVIDUAL
HI04604501Medicaid
HIHEENDOOtherMEDICARE GROUP PTAN
HI0492220001Medicare NSC
HIT41140Medicare UPIN