Provider Demographics
NPI:1194767947
Name:NAM, PATRICK HARRY (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:HARRY
Last Name:NAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1620 N SCHOOL ST
Mailing Address - Street 2:#143
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1851
Mailing Address - Country:US
Mailing Address - Phone:808-845-2221
Mailing Address - Fax:808-845-0177
Practice Address - Street 1:1620 N SCHOOL ST
Practice Address - Street 2:#143
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1851
Practice Address - Country:US
Practice Address - Phone:808-845-2221
Practice Address - Fax:808-845-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI051501-01Medicaid
HIOOOOPGBBXMedicare PIN
HIT41235Medicare UPIN