Provider Demographics
NPI:1811025802
Name:MORINAGA, STACEY MICHIE (OD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MICHIE
Last Name:MORINAGA
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 1:4181 KAANA ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1264
Mailing Address - Country:US
Mailing Address - Phone:808-779-5222
Mailing Address - Fax:
Practice Address - Street 1:4439 PAHEE ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2032
Practice Address - Country:US
Practice Address - Phone:808-246-0051
Practice Address - Fax:808-246-4816
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist