Provider Demographics
NPI:1043356884
Name:PEARL HARBOR VISION CENTER
Entity Type:Organization
Organization Name:PEARL HARBOR VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEILI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-422-2210
Mailing Address - Street 1:1025 QUINCY AVE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4512
Mailing Address - Country:US
Mailing Address - Phone:808-422-2210
Mailing Address - Fax:808-422-2262
Practice Address - Street 1:4725 BOUGAINVILLE DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3179
Practice Address - Country:US
Practice Address - Phone:808-422-2210
Practice Address - Fax:808-422-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty