Provider Demographics
NPI:1578713665
Name:JK OPTICAL INC
Entity Type:Organization
Organization Name:JK OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-735-7773
Mailing Address - Street 1:1142 KOKO HEAD AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3710
Mailing Address - Country:US
Mailing Address - Phone:808-735-7773
Mailing Address - Fax:808-735-7773
Practice Address - Street 1:1142 KOKO HEAD AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3710
Practice Address - Country:US
Practice Address - Phone:808-735-7773
Practice Address - Fax:808-735-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO 184332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64311OtherHMSA
HI499295Medicaid
HI64311OtherHMSA