Provider Demographics
NPI:1417948910
Name:ACKMAN, PETER E (FCLSA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:E
Last Name:ACKMAN
Suffix:
Gender:M
Credentials:FCLSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 UNIVERSITY AVE
Mailing Address - Street 2:#311
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1540
Mailing Address - Country:US
Mailing Address - Phone:808-528-5252
Mailing Address - Fax:808-528-0580
Practice Address - Street 1:1110 UNIVERSITY AVE
Practice Address - Street 2:#311
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1540
Practice Address - Country:US
Practice Address - Phone:808-528-5252
Practice Address - Fax:808-528-0580
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI159156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1083741540OtherNPI NUMBER