Provider Demographics
NPI:1720290828
Name:DRS KUBO AND SATO OPTOMETRISTS INC
Entity Type:Organization
Organization Name:DRS KUBO AND SATO OPTOMETRISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:F
Authorized Official - Last Name:TAKAKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-678-1987
Mailing Address - Street 1:94-1231 KA UKA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4495
Mailing Address - Country:US
Mailing Address - Phone:808-678-1987
Mailing Address - Fax:808-678-6113
Practice Address - Street 1:94-1231 KA UKA BLVD
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-678-1987
Practice Address - Fax:808-678-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH55002Medicare ID - Type Unspecified