Provider Demographics
NPI:1043535404
Name:MAHALO ENTERPRISES CORPORATION
Entity Type:Organization
Organization Name:MAHALO ENTERPRISES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-501-7755
Mailing Address - Street 1:5645 CORAL RIDGE DRIVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076
Mailing Address - Country:US
Mailing Address - Phone:954-501-7755
Mailing Address - Fax:
Practice Address - Street 1:6486 LAKE WORTH ROAD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463
Practice Address - Country:US
Practice Address - Phone:561-968-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHALO ENTERPRISES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-29
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty