Provider Demographics
NPI:1376696310
Name:MELANIETANTISIRA,MD, LLC
Entity Type:Organization
Organization Name:MELANIETANTISIRA,MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTISIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-591-9111
Mailing Address - Street 1:1010 S KING ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1701
Mailing Address - Country:US
Mailing Address - Phone:808-591-9111
Mailing Address - Fax:
Practice Address - Street 1:1010 S KING ST
Practice Address - Street 2:SUITE 503
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1701
Practice Address - Country:US
Practice Address - Phone:808-591-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8838207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty