Provider Demographics
NPI:1598775314
Name:TAKARA, JOANNE C (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:C
Last Name:TAKARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N KUAKINI ST STE 605
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6302
Mailing Address - Country:US
Mailing Address - Phone:808-456-3937
Mailing Address - Fax:808-425-4706
Practice Address - Street 1:1000 KAMEHAMEHA HWY STE 100
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2596
Practice Address - Country:US
Practice Address - Phone:808-456-3937
Practice Address - Fax:808-425-4706
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1863152W00000X
HI447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO530318Medicare ID - Type Unspecified
COU69676Medicare UPIN