Provider Demographics
NPI:1629222484
Name:EYEWEAR HILO, LLC
Entity Type:Organization
Organization Name:EYEWEAR HILO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/SALES/OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HORITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-935-1119
Mailing Address - Street 1:899 ULULANI ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3981
Mailing Address - Country:US
Mailing Address - Phone:808-935-1119
Mailing Address - Fax:808-935-1779
Practice Address - Street 1:899 ULULANI ST STE 2
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3981
Practice Address - Country:US
Practice Address - Phone:808-935-1119
Practice Address - Fax:808-935-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-168156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty