Provider Demographics
NPI:1952640476
Name:CALVIN M. MIURA, M.D., INC.
Entity Type:Organization
Organization Name:CALVIN M. MIURA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:MASARU
Authorized Official - Last Name:MIURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-947-2233
Mailing Address - Street 1:1150 SOUTH KING STREET
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1953
Mailing Address - Country:US
Mailing Address - Phone:808-947-2233
Mailing Address - Fax:808-944-0930
Practice Address - Street 1:1150 SOUTH KING STREET
Practice Address - Street 2:SUITE 1001
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1953
Practice Address - Country:US
Practice Address - Phone:808-947-2233
Practice Address - Fax:808-944-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2077207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI032548Medicaid
HI0924160001Medicare NSC
HIH0000BDBRPMedicare PIN
HI032548Medicaid