Provider Demographics
NPI:1598913121
Name:SOUZA, JANA MIKI'ALA (OD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MIKI'ALA
Last Name:SOUZA
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 1:76 KALANIANAOLE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4744
Mailing Address - Country:US
Mailing Address - Phone:808-333-3233
Mailing Address - Fax:808-315-7663
Practice Address - Street 1:76 KALANIANAOLE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4744
Practice Address - Country:US
Practice Address - Phone:808-333-3233
Practice Address - Fax:808-315-7663
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist