Provider Demographics
NPI:1619118718
Name:MAEHARA EYE SURGERY & LASER LLC
Entity Type:Organization
Organization Name:MAEHARA EYE SURGERY & LASER LLC
Other - Org Name:DENNIS I. MAEHARA, M.D., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:MAEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-671-3782
Mailing Address - Street 1:94-239 WAIPAHU DEPOT STREET
Mailing Address - Street 2:#105
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3095
Mailing Address - Country:US
Mailing Address - Phone:808-671-3782
Mailing Address - Fax:808-671-3782
Practice Address - Street 1:94-239 WAIPAHU DEPOT STREET
Practice Address - Street 2:#105
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3095
Practice Address - Country:US
Practice Address - Phone:808-671-3782
Practice Address - Fax:808-671-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-2131207W00000X
HIMD-11924207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty