Provider Demographics
NPI:1942022074
Name:AMIGO, ANNA W
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:W
Last Name:AMIGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PAKAULA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3508
Mailing Address - Country:US
Mailing Address - Phone:808-871-7104
Mailing Address - Fax:808-871-7812
Practice Address - Street 1:101 PAKAULA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3508
Practice Address - Country:US
Practice Address - Phone:808-871-7104
Practice Address - Fax:808-871-7812
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO521156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician