Provider Demographics
NPI:1720101611
Name:WINDWARD VISION CENTER ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WINDWARD VISION CENTER ASSOCIATES, INC.
Other - Org Name:WINDWARD VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECOND IN COMMAND
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-262-8107
Mailing Address - Street 1:46-056 KAMEHAMEHA HWY
Mailing Address - Street 2:SPC K05
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3768
Mailing Address - Country:US
Mailing Address - Phone:808-235-6641
Mailing Address - Fax:808-247-3880
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:SPC K05
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3768
Practice Address - Country:US
Practice Address - Phone:808-235-6641
Practice Address - Fax:808-247-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI357152W00000X
HI184152W00000X
HI556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0022521OtherHMSA
HI00962401Medicaid
HI547309Medicaid
HI01360601Medicaid
HI0000022525OtherHMSA
HIU40616Medicare UPIN
HIU88135Medicare UPIN
HI547309Medicaid
HI0000022525OtherHMSA
HI0824380002Medicare NSC
HIBY570ZMedicare PIN
HIBY562AMedicare PIN
HI00962401Medicaid