Provider Demographics
NPI:1285792580
Name:GUSHIKEN, ROXANNE M (OD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:M
Last Name:GUSHIKEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:M
Other - Last Name:SUZUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2118
Mailing Address - Country:US
Mailing Address - Phone:808-432-2000
Mailing Address - Fax:
Practice Address - Street 1:1010 PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2118
Practice Address - Country:US
Practice Address - Phone:808-432-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI087119-02Medicaid
HI0000212621OtherHMSA BILLING NUMBER
HIU67540Medicare UPIN
HIH50516Medicare PIN