Provider Demographics
NPI:1730254277
Name:TAKAKI, RANDALL F (OD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:F
Last Name:TAKAKI
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 1:94-1231 KA UKA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4495
Mailing Address - Country:US
Mailing Address - Phone:808-678-1987
Mailing Address - Fax:808-678-6113
Practice Address - Street 1:94-1231 KA UKA BLVD
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4495
Practice Address - Country:US
Practice Address - Phone:808-678-1987
Practice Address - Fax:808-678-6113
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C0063671Medicaid
HIH55003Medicare ID - Type Unspecified