Provider Demographics
NPI:1679331383
Name:NISHIMURA, NICOELLE (ABO, NCLE,)
Entity type:Individual
Prefix:
First Name:NICOELLE
Middle Name:
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:ABO, NCLE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-465 POHAKUPUNA RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2348
Mailing Address - Country:US
Mailing Address - Phone:808-295-0387
Mailing Address - Fax:
Practice Address - Street 1:94-595 KUPUOHI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5382
Practice Address - Country:US
Practice Address - Phone:808-688-0700
Practice Address - Fax:808-688-1615
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-515156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician