Provider Demographics
NPI:1750355764
Name:MATSUYAMA, WAYNE SUSUMU (OD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:SUSUMU
Last Name:MATSUYAMA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:98-150 KAONOHI ST
Mailing Address - Street 2:SUITE B211
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5047
Mailing Address - Country:US
Mailing Address - Phone:808-486-3937
Mailing Address - Fax:808-486-3386
Practice Address - Street 1:98-150 KAONOHI ST
Practice Address - Street 2:SUITE B211
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5047
Practice Address - Country:US
Practice Address - Phone:808-486-3937
Practice Address - Fax:808-486-3386
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist