Provider Demographics
NPI:1316192081
Name:KAUAI OPHTHALMOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KAUAI OPHTHALMOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-346-7797
Mailing Address - Street 1:4366 KUKUI GROVE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-346-7797
Mailing Address - Fax:
Practice Address - Street 1:3430A KALUA MOA RD
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-8622
Practice Address - Country:US
Practice Address - Phone:808-346-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-23
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 13717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty