Provider Demographics
NPI:1528008208
Name:BIG ISLAND OPTICAL, INC
Entity Type:Organization
Organization Name:BIG ISLAND OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIRONAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-935-1360
Mailing Address - Street 1:1216 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4134
Mailing Address - Country:US
Mailing Address - Phone:808-935-1360
Mailing Address - Fax:808-935-1383
Practice Address - Street 1:1216 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4134
Practice Address - Country:US
Practice Address - Phone:808-935-1360
Practice Address - Fax:808-935-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20294426-01332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08143202Medicaid
HI08143202Medicaid