Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD-940 | HI |
NPI | 1003429085 |
---|---|
Provider Name | Courtney Muraoka |
First Address | Honolulu, HI 96820-2360 |
Second Address | Waipahu, HI 96797-5382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OD-940 | MEDICAL LICENSE (01) | HI |