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 1:2040 OAKTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9696
Mailing Address - Country:US
Mailing Address - Phone:919-346-6945
Mailing Address - Fax:919-651-1052
Practice Address - Street 1:958 VANDORA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3544
Practice Address - Country:US
Practice Address - Phone:919-346-6945
Practice Address - Fax:919-651-1052
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2024-08-11
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
P01191566OtherRAILROAD MEDICARE
NC0933POtherBCBS NC
NC5918063Medicaid
NCNC0190IMedicare PIN
P01191566OtherRAILROAD MEDICARE
NCNC0190DMedicare PIN
NCNC0190GMedicare PIN
NCNC0190JMedicare PIN
NCNC0190CMedicare PIN
NCNC0190LMedicare PIN
NCNC0190BMedicare PIN
NC0933POtherBCBS NC
NCNC0190KMedicare PIN
NCNC0190FMedicare PIN
NCNC0190HMedicare PIN