Provider Demographics
NPI:1922197185
Name:KAWAI, STANLEY T (OD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:T
Last Name:KAWAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:T
Other - Last Name:KAWAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10502 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6528
Mailing Address - Country:US
Mailing Address - Phone:714-776-2020
Mailing Address - Fax:714-776-1618
Practice Address - Street 1:10502 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6528
Practice Address - Country:US
Practice Address - Phone:714-776-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP9273T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0092730OtherNORTHERN MEDICARE PROVIDER
CASD0092731Medicaid
CAOP9273TOtherLICENSE
CASD0092731Medicaid
CAOP9273TOtherLICENSE