Provider Demographics
NPI:1447456835
Name:SAKAMOTO EYE CLINIC, LLC
Entity type:Organization
Organization Name:SAKAMOTO EYE CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:808-330-9256
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4408
Mailing Address - Country:US
Mailing Address - Phone:808-944-9911
Mailing Address - Fax:808-944-9913
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 2005
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4408
Practice Address - Country:US
Practice Address - Phone:808-944-9911
Practice Address - Fax:808-944-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI59720501Medicaid
HI102648Medicare PIN