Provider Demographics
NPI:1780808352
Name:MIYASHIRO, GRANT TADASHI (OD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:TADASHI
Last Name:MIYASHIRO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29729
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2129
Mailing Address - Country:US
Mailing Address - Phone:808-935-8887
Mailing Address - Fax:808-935-1982
Practice Address - Street 1:34 W KAWAILANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5649
Practice Address - Country:US
Practice Address - Phone:808-935-8887
Practice Address - Fax:808-892-5882
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIU72340Medicare UPIN
HI56768Medicare ID - Type Unspecified