Glenn Mikio Watanabe, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD-151 Issued in HI

Practice address

94-239 Waipahu Depot St
#213
Waipahu, HI 96797-3056

Phone

(808) 671-2888

Fax

(808) 676-1097

NPI assigned

Jan 28, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1689720880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94-239 WAIPAHU DEPOT ST",
            "address_2": "#213",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973056",
            "telephone_number": "808-671-2888",
            "fax_number": "808-676-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94-239 WAIPAHU DEPOT ST",
            "address_2": "#213",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973056",
            "telephone_number": "808-671-2888",
            "fax_number": "808-676-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "GLENN",
        "middle_name": "MIKIO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-28",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "HI",
            "license": "OD-151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04677102",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sally Watters
• Kyla A Watts
• Waves of Aloha LLC (Phiten Hawaii)
• Charity Weaver-Phillips

• Optometrist in Waipahu, HI
• Providers in Waipahu, HI by specialty
• Optometrist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.