Provider Demographics
NPI:1588740997
Name:TOM, DEWEY WK (OD)
Entity type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:WK
Last Name:TOM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:45-955 KAMEHAMEHA HWY
Mailing Address - Street 2:ROOM 104
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3222
Mailing Address - Country:US
Mailing Address - Phone:808-247-3063
Mailing Address - Fax:808-235-4973
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:ROOM 104
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-247-3063
Practice Address - Fax:808-235-4973
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05133601Medicaid
H100013Medicare PIN