Provider Demographics
NPI:1801028626
Name:DR. RAE NAGAHIRO
Entity Type:Organization
Organization Name:DR. RAE NAGAHIRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAGAHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-667-9556
Mailing Address - Street 1:364 KIELE ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2111
Mailing Address - Country:US
Mailing Address - Phone:808-667-9556
Mailing Address - Fax:808-667-9557
Practice Address - Street 1:840 WAINEE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2319
Practice Address - Country:US
Practice Address - Phone:808-667-9556
Practice Address - Fax:808-667-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5209680001Medicare NSC