Provider Demographics
NPI:1407039217
Name:TOM EYECARE LLC
Entity Type:Organization
Organization Name:TOM EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:GM
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-247-3063
Mailing Address - Street 1:45-955 KAMEHAMEHA HWY
Mailing Address - Street 2:ROOM 104
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3222
Mailing Address - Country:US
Mailing Address - Phone:808-247-3063
Mailing Address - Fax:808-235-4973
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:ROOM 104
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-247-3063
Practice Address - Fax:808-235-4973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI102152W00000X
HI615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05133601Medicaid
HI56349601Medicaid
HIH100011Medicare PIN