Provider Demographics
NPI:1255682811
Name:PACIFIC VISION INSTITUTE INC
Entity Type:Organization
Organization Name:PACIFIC VISION INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-428-3288
Mailing Address - Street 1:1401 S BERETANIA ST
Mailing Address - Street 2:#560
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-728-6728
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:#560
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-428-3288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12121207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHD136AMedicare PIN