Provider Demographics
NPI:1538164322
Name:OTTO, CLIFTON SAUNDERS (MD)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:SAUNDERS
Last Name:OTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:MAILCODE 61323
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-955-0255
Mailing Address - Fax:808-955-4155
Practice Address - Street 1:1620 ALA MOANA BLVD
Practice Address - Street 2:STE 500
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815
Practice Address - Country:US
Practice Address - Phone:808-955-0255
Practice Address - Fax:808-955-4155
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD12486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI593534Medicaid
HIH102800Medicare PIN