Provider Demographics
NPI:1225192214
Name:SAKKA, BRYAN N (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:N
Last Name:SAKKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-226 WAIKALUA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3134
Mailing Address - Country:US
Mailing Address - Phone:808-235-1683
Mailing Address - Fax:808-247-7888
Practice Address - Street 1:45-600 KAMEHAMEHA HWY
Practice Address - Street 2:#A
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2017
Practice Address - Country:US
Practice Address - Phone:808-236-1029
Practice Address - Fax:808-247-7888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05651701Medicaid
HIU11373Medicare UPIN
HI0000PGBJCMedicare ID - Type UnspecifiedMEDICARE
HIFW098AMedicare PIN