Provider Demographics
NPI:1962503813
Name:MIWA, WAYNE N (OD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:N
Last Name:MIWA
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 1:98030 HEKAHA ST
Mailing Address - Street 2:#11
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4900
Mailing Address - Country:US
Mailing Address - Phone:808-486-8484
Mailing Address - Fax:
Practice Address - Street 1:98030 HEKAHA ST
Practice Address - Street 2:#11
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4900
Practice Address - Country:US
Practice Address - Phone:808-486-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH101908Medicare PIN
HIU08394Medicare UPIN