Provider Demographics
NPI:1467758078
Name:KOIDE OBARA, KELLY ANN LISA (OD)
Entity type:Individual
Prefix:MS
First Name:KELLY ANN
Middle Name:LISA
Last Name:KOIDE OBARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:46-056 KAMEHAMEHA HWY STE 251
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-6707
Mailing Address - Country:US
Mailing Address - Phone:808-235-6641
Mailing Address - Fax:
Practice Address - Street 1:46-056 KAMEHAMEHA HWY STE 251
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-6707
Practice Address - Country:US
Practice Address - Phone:808-235-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist