Provider Demographics
NPI:1134696305
Name:HARRISON, KIIRA (OD)
Entity Type:Individual
Prefix:
First Name:KIIRA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 KAPAHULU AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1332
Mailing Address - Country:US
Mailing Address - Phone:808-782-1861
Mailing Address - Fax:
Practice Address - Street 1:1029 KAPAHULU AVE STE 502
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-782-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34025TLG152W00000X
HIOD-893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist