Healthcare Provider Details

I. General information

NPI: 1598219834
Provider Name (Legal Business Name): NICHOLAS KLAUBA I O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-901 KUHIO HWY STE B
KAPAA HI
96746-1549
US

IV. Provider business mailing address

4-901 KUHIO HWY STE B
KAPAA HI
96746-1549
US

V. Phone/Fax

Practice location:
  • Phone: 808-822-3733
  • Fax: 808-822-7355
Mailing address:
  • Phone: 808-822-3733
  • Fax: 808-822-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD865
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: