Provider Demographics
NPI:1316119423
Name:SHIBAYAMA, WENDI NOBUKO HARADA (OD)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:NOBUKO HARADA
Last Name:SHIBAYAMA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:WENDI
Other - Middle Name:NOBUKO
Other - Last Name:HARADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:91-600 FARRINGTON HWY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4509
Mailing Address - Country:US
Mailing Address - Phone:808-674-4488
Mailing Address - Fax:
Practice Address - Street 1:91-600 FARRINGTON HWY UNIT 3
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4509
Practice Address - Country:US
Practice Address - Phone:808-674-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HICP278ZOtherMEDICARE PTAN ASSOCIATED WITH GROUP NPI 1215266523
HICP278ZMedicare UPIN
HICP278ZOtherMEDICARE PTAN ASSOCIATED WITH GROUP NPI 1215266523