Provider Demographics
NPI:1700011996
Name:FAMILY EYE CARE ASSOCIATES-KAPOLEI, LLC.
Entity Type:Organization
Organization Name:FAMILY EYE CARE ASSOCIATES-KAPOLEI, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:NAKAGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-674-0085
Mailing Address - Street 1:1001 KAMOKILA BLVD # 108
Mailing Address - Street 2:JAMES CAMPBELL BLDG.
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 # 108
Practice Address - Street 2:JAMES CAMPBELL BLDG.
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000238154Medicaid
HICF799AMedicare PIN
HIU91758Medicare UPIN