Provider Demographics
NPI:1679792089
Name:PATRICK H. NAM, O.D., INC.
Entity type:Organization
Organization Name:PATRICK H. NAM, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-845-2221
Mailing Address - Street 1:2232 KAPIOLANI BLVD
Mailing Address - Street 2:#902
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4343
Mailing Address - Country:US
Mailing Address - Phone:808-845-2221
Mailing Address - Fax:
Practice Address - Street 1:1620 N SCHOOL ST
Practice Address - Street 2:#143
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1844
Practice Address - Country:US
Practice Address - Phone:808-845-2221
Practice Address - Fax:808-845-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05010101Medicaid
HIHPNAMMedicare PIN
HIT41235Medicare UPIN
HI05010101Medicaid