Provider Demographics
NPI:1972057123
Name:TASAKA, SHELLEY (OD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:TASAKA
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 1:46-056 KAMEHAMEHA HWY
Mailing Address - Street 2:#251
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:#251
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-235-6641
Practice Address - Fax:808-247-3880
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist