Provider Demographics
NPI:1396807020
Name:NAKAMOTO, RALPH (OD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:NAKAMOTO
Suffix:
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:808-487-3645
Mailing Address - Fax:
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:808-487-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000PGBMGOtherMEDICARE PIN#
HI5883-4OtherHMSA PIN#
HIG50140OtherNARCOTICS ENFORCEMENT DIV
HI116OtherHAWAII OPTOMETRY LICENSE
HI0000PGBMGOtherMEDICARE PIN#
HI116OtherHAWAII OPTOMETRY LICENSE