Provider Demographics
NPI:1508171364
Name:NAKAGAWARA, ESTHER MH (OD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:MH
Last Name:NAKAGAWARA
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 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:2075 RENAISSANCE PARK PL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2263
Practice Address - Country:US
Practice Address - Phone:919-861-7784
Practice Address - Fax:919-846-3951
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918063Medicaid
P01191566OtherRAILROAD MEDICARE
NC0933POtherBCBS NC
NCNC0190IMedicare PIN
P01191566OtherRAILROAD MEDICARE
NCNC0190DMedicare PIN
NCNC0190GMedicare PIN
NCNC0190JMedicare PIN
NCNC0190CMedicare PIN
NCNC0190LMedicare PIN
NCNC0190BMedicare PIN
NC0933POtherBCBS NC
NCNC0190KMedicare PIN
NCNC0190FMedicare PIN
NCNC0190HMedicare PIN