Provider Demographics
NPI:1518231885
Name:TIMOTHY H. MOON, O.D. INC.
Entity Type:Organization
Organization Name:TIMOTHY H. MOON, O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HYUNCHOL
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-946-7700
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:312
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-946-7700
Mailing Address - Fax:808-946-7710
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:312
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-946-7700
Practice Address - Fax:808-946-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA20813-0OtherHMSA
A20813-0OtherHMSA QUEST
HI49451801Medicaid
HIA20813-0OtherHMSA
HI49451801Medicaid