Provider Demographics
NPI:1245544113
Name:DR. EARLE H. NAKAGAWA OPTOMETRIST LLC
Entity type:Organization
Organization Name:DR. EARLE H. NAKAGAWA OPTOMETRIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWVER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARLE
Authorized Official - Middle Name:HIDETSUGU
Authorized Official - Last Name:NAKAGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-247-6696
Mailing Address - Street 1:45-1123 KAM HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3242
Mailing Address - Country:US
Mailing Address - Phone:808-247-6696
Mailing Address - Fax:808-247-6663
Practice Address - Street 1:45-1123 KAM HWY
Practice Address - Street 2:SUITE C
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3242
Practice Address - Country:US
Practice Address - Phone:808-247-6696
Practice Address - Fax:808-247-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI039940-01Medicaid
HIH54795Medicare PIN
HIT41230Medicare UPIN