Provider Demographics
NPI:1285755322
Name:WAWRZENSKI, HEATHER M (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:WAWRZENSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:TEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1000 KAMEHAMEHA HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2596
Mailing Address - Country:US
Mailing Address - Phone:808-388-5215
Mailing Address - Fax:
Practice Address - Street 1:1000 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2881
Practice Address - Country:US
Practice Address - Phone:808-456-3937
Practice Address - Fax:808-454-0683
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12888152W00000X
HIOD635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist