Provider Demographics
NPI:1104982768
Name:KAOPUA, ISAAC J JR (OD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:J
Last Name:KAOPUA
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1247 KAAHUMANU ST
Mailing Address - Street 2:SUITE #116
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5311
Mailing Address - Country:US
Mailing Address - Phone:808-488-4000
Mailing Address - Fax:808-488-7667
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:SUITE #116
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5311
Practice Address - Country:US
Practice Address - Phone:808-488-4000
Practice Address - Fax:808-488-7667
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000018895OtherQUEST
HI01759901Medicaid
HI1889-5OtherHAWAII MEDICAL SERVICE AS
HIHOOOOPGBMVMedicare ID - Type Unspecified
HI01759901Medicaid