Provider Demographics
NPI:1386025625
Name:MEAD, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2120 FERN ST
Mailing Address - Street 2:305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:932 WARD AVE
Practice Address - Street 2:600
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2131
Practice Address - Country:US
Practice Address - Phone:808-535-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1018225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner