Provider Demographics
NPI:1871596296
Name:MITSUI, CEDRIC (OD)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:MITSUI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899-A ULULANI STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-935-3937
Mailing Address - Fax:808-935-3882
Practice Address - Street 1:899-A ULULANI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-3937
Practice Address - Fax:808-935-3882
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-06-09
Provider Licenses
StateLicense IDTaxonomies
HIOD320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI075767-01Medicaid
HI075767-01Medicaid
HIU62241Medicare UPIN