Provider Demographics
NPI:1295731073
Name:MURATA, CLARENCE Y (OD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:Y
Last Name:MURATA
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 1:66-210 KAMEHAMEHA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-2408
Mailing Address - Country:US
Mailing Address - Phone:808-637-5048
Mailing Address - Fax:808-637-5048
Practice Address - Street 1:66-210 KAMEHAMEHA HWY STE A
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-2408
Practice Address - Country:US
Practice Address - Phone:808-637-5048
Practice Address - Fax:808-637-5048
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2011-09-28
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
HI131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI041436-01Medicaid
HI041436-01Medicaid
HIFI934ZMedicare PIN
HIT41227Medicare ID - Type Unspecified