Provider Demographics
NPI:1073616603
Name:BAIZE, KEVIN NEPHI (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:NEPHI
Last Name:BAIZE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55-510 KAM HWY
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1138
Mailing Address - Country:US
Mailing Address - Phone:808-293-9500
Mailing Address - Fax:808-293-1890
Practice Address - Street 1:55-510 KAM HWY
Practice Address - Street 2:SUITE 17
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762
Practice Address - Country:US
Practice Address - Phone:808-293-9500
Practice Address - Fax:808-293-1890
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03407701Medicaid
HI37630OtherHAWAII MEDICAL SERVICE AS
HI122685OtherDESERET MUTUAL DMBA
U41667Medicare UPIN
HI37630OtherHAWAII MEDICAL SERVICE AS