Provider Demographics
NPI:1649725698
Name:IMAOKA, COLIN GORO (OD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:GORO
Last Name:IMAOKA
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 1:95-1031 KELAKELA ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5991
Mailing Address - Country:US
Mailing Address - Phone:808-554-4957
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD SPC 202
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4773
Practice Address - Country:US
Practice Address - Phone:808-488-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI964152W00000X
AZ2129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist