Provider Demographics
NPI:1114048840
Name:TAKEDA, YUKO (OD)
Entity Type:Individual
Prefix:
First Name:YUKO
Middle Name:
Last Name:TAKEDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:YUKO
Other - Middle Name:
Other - Last Name:TAKEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1350 ALA MOANA BLVD
Mailing Address - Street 2:#3008
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4216
Mailing Address - Country:US
Mailing Address - Phone:808-964-1664
Mailing Address - Fax:808-356-1601
Practice Address - Street 1:1350 ALA MOANA BLVD
Practice Address - Street 2:#3008
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4216
Practice Address - Country:US
Practice Address - Phone:808-964-1664
Practice Address - Fax:808-944-0090
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HICK599ZMedicare PIN