Provider Demographics
NPI:1093908089
Name:BIG ISLAND OPTICAL INC
Entity Type:Organization
Organization Name:BIG ISLAND OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:TAKEO
Authorized Official - Last Name:HIRONAGA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE OPTICIAN
Authorized Official - Phone:808-935-1360
Mailing Address - Street 1:64-1032 MAMALAHOA HWY
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-887-1973
Mailing Address - Fax:808-881-8578
Practice Address - Street 1:64-1032 MAMALAHOA HWY
Practice Address - Street 2:UNIT 1A
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743
Practice Address - Country:US
Practice Address - Phone:808-887-1973
Practice Address - Fax:808-881-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08402801Medicaid
HI0731780002Medicare PIN