Provider Demographics
NPI:1073844999
Name:EYE CENTER OF HAWAII LLC
Entity Type:Organization
Organization Name:EYE CENTER OF HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-955-0255
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:MAILCODE 61324
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-329-2010
Mailing Address - Fax:808-329-2530
Practice Address - Street 1:77-6403 NALANI ST UNIT 2
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9763
Practice Address - Country:US
Practice Address - Phone:808-329-2010
Practice Address - Fax:808-329-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI643264Medicaid
HIDQ2190OtherRR MEDICARE
HIDQ2190OtherRR MEDICARE