Provider Demographics
NPI:1679598619
Name:NAKAGAWA, TODD KYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:KYLE
Last Name:NAKAGAWA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-0085
Mailing Address - Fax:808-674-8785
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:#108
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-0085
Practice Address - Fax:808-674-8785
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI532219-01Medicaid
HICF799AOtherMEDICARE PIN GROUP NUMBER 1700011996
HICF799AOtherMEDICARE PIN GROUP NUMBER 1700011996
HICF799AMedicare PIN