Provider Demographics
NPI:1063543676
Name:YAMAMOTO, WALTER M (OD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:M
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:99-205 MOANALUA RD
Mailing Address - Street 2:STE 210
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-487-1010
Mailing Address - Fax:808-488-3433
Practice Address - Street 1:99-205 MOANALUA RD
Practice Address - Street 2:STE 210
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4088
Practice Address - Country:US
Practice Address - Phone:808-487-1010
Practice Address - Fax:808-488-3433
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIO.D. 172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI990331542OtherVSP
HIWALTER M YAMAMOTO OCOtherHMA INC DBA HEALTH MGMT
HIHWYAMAOtherMEDICARE NUMBER
HIA001258-1OtherHMSA
HI990331542OtherUHA
HI990331542OtherKAISER PERMANENTE
HI990331542OtherVSP
HIA001258-1OtherHMSA
HIWALTER M YAMAMOTO OCOtherHMA INC DBA HEALTH MGMT