Provider Demographics
NPI:1265686166
Name:HORITA, DIANN H
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:H
Last Name:HORITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 ULULANI ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3981
Mailing Address - Country:US
Mailing Address - Phone:808-935-1119
Mailing Address - Fax:808-935-1779
Practice Address - Street 1:899 ULULANI ST STE 2
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3981
Practice Address - Country:US
Practice Address - Phone:808-935-1119
Practice Address - Fax:808-935-1779
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-168156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician