Provider Demographics
NPI:1336142884
Name:THE SURGICAL SUITES LLC
Entity Type:Organization
Organization Name:THE SURGICAL SUITES LLC
Other - Org Name:FAULKNER INSTITUTE FOR EYE CARE & SURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:OMPHROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-625-5577
Mailing Address - Street 1:1100 WARD AVE
Mailing Address - Street 2:STE 1001
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1617
Mailing Address - Country:US
Mailing Address - Phone:808-531-0127
Mailing Address - Fax:808-531-0455
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:STE 1001
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1617
Practice Address - Country:US
Practice Address - Phone:808-531-0127
Practice Address - Fax:808-531-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIFSOF-5261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5516OtherALOHA CARE
HI022176-2OtherHMSA
HI088307-01Medicaid
HI088307-01Medicaid