Healthcare Provider Details

I. General information

NPI: 1114833191
Provider Name (Legal Business Name): JESSICA GULASKEY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 ULULANI ST
HILO HI
96720-2930
US

IV. Provider business mailing address

199 ULULANI ST
HILO HI
96720-2930
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-2964
  • Fax: 808-935-2964
Mailing address:
  • Phone: 808-961-6421
  • Fax: 808-961-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD-1074
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: