Provider Demographics
NPI:1902927718
Name:TANAKA, ALAN Y (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:Y
Last Name:TANAKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22998
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2998
Mailing Address - Country:US
Mailing Address - Phone:808-732-1566
Mailing Address - Fax:
Practice Address - Street 1:98-1256 KAAHUMANU ST STE E101
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3282
Practice Address - Country:US
Practice Address - Phone:808-732-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0266153OtherHMSA