Provider Demographics
NPI:1801988894
Name:HONDA, JAY K
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:K
Last Name:HONDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:K
Other - Last Name:HONDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:75-166 KALANI ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1857
Mailing Address - Country:US
Mailing Address - Phone:808-329-3535
Mailing Address - Fax:888-242-1855
Practice Address - Street 1:75-166 KALANI ST
Practice Address - Street 2:STE. 102
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1857
Practice Address - Country:US
Practice Address - Phone:808-329-3535
Practice Address - Fax:888-242-1855
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIU29307Medicare UPIN
HI0261090002Medicare NSC