Provider Demographics
NPI:1831820984
Name:BRIAN M TERUYA OD INC
Entity type:Organization
Organization Name:BRIAN M TERUYA OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERUYA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-734-4343
Mailing Address - Street 1:PO BOX 29960
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2360
Mailing Address - Country:US
Mailing Address - Phone:808-734-4343
Mailing Address - Fax:808-734-3930
Practice Address - Street 1:3221 WAIALAE AVE STE 340
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5831
Practice Address - Country:US
Practice Address - Phone:808-734-4343
Practice Address - Fax:808-734-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
152W00000XOtherOPTOMETRY