Provider Demographics
NPI:1457337909
Name:INOUCHI, TRACIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:M
Last Name:INOUCHI
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 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:#1110
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-949-2662
Mailing Address - Fax:808-947-0120
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4406
Practice Address - Country:US
Practice Address - Phone:808-949-2662
Practice Address - Fax:808-947-0120
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1477847358OtherPRACTICE NPI NUMBER
HIH55261OtherPROVIDER TRANSACTION ACCOUNT NUMBER (PTAN)
HI51809501Medicaid
HIH55261OtherPROVIDER TRANSACTION ACCOUNT NUMBER (PTAN)
HI51809501Medicaid