Provider Demographics
NPI:1427005644
Name:BIG ISLAND VISION CENTER
Entity Type:Organization
Organization Name:BIG ISLAND VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-935-3937
Mailing Address - Street 1:899-A ULULANI STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-935-3937
Mailing Address - Fax:808-935-3882
Practice Address - Street 1:899 ULULANI ST
Practice Address - Street 2:A
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-3937
Practice Address - Fax:808-935-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI075767-01Medicaid
HI50563Medicare UPIN