Provider Demographics
NPI:1255720223
Name:WALLY KOJIMA OD LLC
Entity type:Organization
Organization Name:WALLY KOJIMA OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-331-8081
Mailing Address - Street 1:73 5600 MAIAU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2630
Mailing Address - Country:US
Mailing Address - Phone:808-331-8081
Mailing Address - Fax:808-331-8081
Practice Address - Street 1:73 5600 MAIAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2630
Practice Address - Country:US
Practice Address - Phone:808-331-8081
Practice Address - Fax:808-331-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty