Provider Demographics
NPI:1558614370
Name:SLATER, RACHEL (OD)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KUROHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 LANIHULI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7205
Mailing Address - Country:US
Mailing Address - Phone:808-967-4711
Mailing Address - Fax:
Practice Address - Street 1:47 LANIHULI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7205
Practice Address - Country:US
Practice Address - Phone:808-967-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000372060Medicaid
HIH108760Medicare PIN