Provider Demographics
NPI:1699853150
Name:MAEDA, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MAEDA
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 1:1234 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4282
Mailing Address - Country:US
Mailing Address - Phone:808-935-5228
Mailing Address - Fax:808-969-9117
Practice Address - Street 1:1234 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4206
Practice Address - Country:US
Practice Address - Phone:808-935-5228
Practice Address - Fax:808-969-9117
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI7786656OtherUHA MEDICAL
HI253237OtherHMSA PROVIDER NUMBER
HI574170-01Medicaid
HI778665620OtherUHA VISION
HIH100356OtherHAWAII MEDICARE