Provider Demographics
NPI:1750555132
Name:ROGER CHRISTIAN EDE, O.D., INC.
Entity type:Organization
Organization Name:ROGER CHRISTIAN EDE, O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:EDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-696-7021
Mailing Address - Street 1:86-120 FARRINGTON HWY
Mailing Address - Street 2:SUITE C301
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3000
Mailing Address - Country:US
Mailing Address - Phone:808-696-7021
Mailing Address - Fax:808-696-3075
Practice Address - Street 1:86-120 FARRINGTON HWY
Practice Address - Street 2:SUITE C301
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3000
Practice Address - Country:US
Practice Address - Phone:808-696-7021
Practice Address - Fax:808-696-3075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGER CHRISTIAN EDE, O.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-17
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0406020002Medicare NSC
HIHREDEMedicare PIN