Provider Demographics
NPI:1427278522
Name:JORGE CUAN, CANDIDO (STATE LICENSED OPTIC)
Entity type:Individual
Prefix:MR
First Name:CANDIDO
Middle Name:
Last Name:JORGE CUAN
Suffix:
Gender:M
Credentials:STATE LICENSED OPTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925-F MAUNAKEA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5166
Mailing Address - Country:US
Mailing Address - Phone:808-523-0082
Mailing Address - Fax:808-523-0083
Practice Address - Street 1:925-F MAUNAKEA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5166
Practice Address - Country:US
Practice Address - Phone:808-523-0082
Practice Address - Fax:808-523-0083
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI257156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
192295OtherHMA
HI228866OtherNMSA
HI50853301Medicaid