Provider Demographics
NPI:1215266523
Name:WENDI N HARADA OD INC
Entity type:Organization
Organization Name:WENDI N HARADA OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-247-8391
Mailing Address - Street 1:46-056 KAMEHAMEHA HWY STE 150
Mailing Address - Street 2:ATTN: SEARS OPTICAL
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-6702
Mailing Address - Country:US
Mailing Address - Phone:808-247-8391
Mailing Address - Fax:808-236-1594
Practice Address - Street 1:46-056 KAMEHAMEHA HWY STE 150
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-6702
Practice Address - Country:US
Practice Address - Phone:808-247-8391
Practice Address - Fax:808-236-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HICP259OtherMEDICARE PTAN
HICP259Medicare PIN
HICP259OtherMEDICARE PTAN