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Individual

DR. ROGER CHRISTIAN EDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
377 KEAHOLE ST, HONOLULU, HI 96825-3405
(808) 396-6311
(808) 395-2448
Mailing address
94-050 FARRINGTON HWY, STE B1-1, WAIPAHU, HI 96797-1800
(808) 677-1544
(808) 671-3538

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
103
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0406020001
MEDICARE SUPPLIER
HI
01
0406020002
MEDICARE SUPPLIER
HI
01
0406020005
MEDICARE SUPPLIER
HI
Enumeration date
11/17/2005
Last updated
09/19/2019
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