Provider Demographics
NPI:1215008594
Name:KAMAAINA VISION CENTER
Entity Type:Organization
Organization Name:KAMAAINA VISION CENTER
Other - Org Name:THE EYEGLASS SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:GW
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-949-7288
Mailing Address - Street 1:508 ATKINSON DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4728
Mailing Address - Country:US
Mailing Address - Phone:808-949-7288
Mailing Address - Fax:
Practice Address - Street 1:508 ATKINSON DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4728
Practice Address - Country:US
Practice Address - Phone:808-949-7288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20275556-01332900000X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332900000XSuppliersNon-Pharmacy Dispensing Site
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI198779-01OtherHMA-60 AFL CLAIM
HI0000059626OtherHMSA QUEST CLAIM
HI05213901Medicaid
HI198779-11OtherHMA-0869 TEAMSTERS CLAIM
HI59626OtherHMSA CLAIM
HI=========OtherCARPENTERS CLAIM
HI05213901Medicaid
HI0000059626OtherHMSA QUEST CLAIM