Individual
DR. COLLEEN MARIKO ICHIYAMA-KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2049 WELLS ST, SUITE #1, WAILUKU, HI 96793-2239
(808) 244-8034
(808) 244-8035
Mailing address
2049 WELLS ST, SUITE #1, WAILUKU, HI 96793-2239
(808) 244-8034
(808) 244-8035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD478
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50181802
—
HI
Enumeration date
06/01/2006
Last updated
11/14/2007
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