Provider Demographics
NPI:1346363363
Name:EYE CARE CENTER OF KAUAI LLC
Entity Type:Organization
Organization Name:EYE CARE CENTER OF KAUAI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-246-0051
Mailing Address - Street 1:4366 KUKUI GROVE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-246-0051
Mailing Address - Fax:808-246-4816
Practice Address - Street 1:4366 KUKUI GROVE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-246-0051
Practice Address - Fax:808-246-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD601152W00000X
HIMD5846156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC97472Medicare UPIN
HIH102863Medicare PIN
HIU90805Medicare UPIN