Andrew Y Maeda OD a Professional Corporation
Organization Active NPI Optometrist · Hilo, HI
NPI 1720206667 · NPPES record last updated Jun 30, 2023
Key facts
- NPI
- 1720206667
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ANDREW Y MAEDA OD A PROFESSIONAL CORPORATION
- Practice address
- 1234 Kilauea Ave
Hilo, HI 96720-4206 - Phone
- (808) 935-5228
- Fax
- (808) 969-9117
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Jennifer M Maeda, O.D.
- Title
- Optometrist
- Phone
- (808) 935-5228
Practitioners 2
-
Jennifer Maeda, O.D.
-
Andrew Yoshimitsu Maeda, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050502001008 | HI | Part B Supplier - Clinic/Group Practice | 6103865878 |
Receives reassigned benefits from 2 practitioners Practice locations: Hilo, HI |
National Provider Directory
Locations
1234 Kilauea Ave
Hilo, HI 96720
Phone (808) 935-5228
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1234 Kilauea Ave
Hilo, HI 96720-4206
Mailing address
1234 Kilauea Ave
Hilo, HI 96720-4282
Phone (808) 935-5228
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H100355 | Other | HI | HAWAII MEDICARE |
Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.