Provider Demographics
NPI:1265788806
Name:ROBB T. SHIBAYAMA, O.D., INC
Entity type:Organization
Organization Name:ROBB T. SHIBAYAMA, O.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBB
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIBAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-225-7622
Mailing Address - Street 1:1228 ALA AUPAKA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2232
Mailing Address - Country:US
Mailing Address - Phone:808-225-7622
Mailing Address - Fax:808-945-9859
Practice Address - Street 1:750 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3014
Practice Address - Country:US
Practice Address - Phone:808-945-3937
Practice Address - Fax:808-945-9859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBB T. SHIBAYAMA, O.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-01
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIGM370AOtherMEDICARE PTAN
HIGM370AOtherMEDICARE PTAN
HIGM370AMedicare UPIN