Provider Demographics
NPI:1386706414
Name:ORIDE, MICHAEL KH (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KH
Last Name:ORIDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170-B JERVES STREET
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-245-8765
Mailing Address - Fax:808-245-8816
Practice Address - Street 1:3170-B JERVES STREET
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-245-8765
Practice Address - Fax:808-245-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02348401Medicaid
HI02606-2OtherHMSA
HI02606-2OtherHMSA
HI55291Medicare ID - Type Unspecified
ORLDM410Medicare PIN