Provider Demographics
NPI:1962669077
Name:DR. ISAAC J. KAOPUA JR. OD, INC.
Entity type:Organization
Organization Name:DR. ISAAC J. KAOPUA JR. OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAOPUA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:808-488-4000
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 116
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 116
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-488-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1889-5OtherHMSA
HI01759901Medicaid