Provider Demographics
NPI:1235183815
Name:POON, LESLIE SH (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:SH
Last Name:POON
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 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3503
Mailing Address - Country:US
Mailing Address - Phone:808-596-4445
Mailing Address - Fax:808-596-4479
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3503
Practice Address - Country:US
Practice Address - Phone:808-596-4445
Practice Address - Fax:808-596-4479
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05975101Medicaid
HIU17124Medicare UPIN
HIH102749Medicare PIN