Provider Demographics
NPI:1962521955
Name:DOUGLAS T. SHIRO, O.D., INC.
Entity type:Organization
Organization Name:DOUGLAS T. SHIRO, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-961-0635
Mailing Address - Street 1:31 EAST LANIKAULA STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4362
Mailing Address - Country:US
Mailing Address - Phone:808-961-0635
Mailing Address - Fax:808-961-0636
Practice Address - Street 1:31 EAST LANIKAULA STREET
Practice Address - Street 2:SUITE D
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4362
Practice Address - Country:US
Practice Address - Phone:808-961-0635
Practice Address - Fax:808-961-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH0000PCBPWMedicare PIN
HI0267260001Medicare NSC