Provider Demographics
NPI:1639114846
Name:GARY EDWARDS MD INC
Entity Type:Organization
Organization Name:GARY EDWARDS MD INC
Other - Org Name:HONOLULU EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-526-0030
Mailing Address - Street 1:1329 LUSITANA ST STE 806
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2435
Mailing Address - Country:US
Mailing Address - Phone:808-526-0030
Mailing Address - Fax:808-521-2823
Practice Address - Street 1:1329 LUSITANA ST STE 806
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2435
Practice Address - Country:US
Practice Address - Phone:808-526-0030
Practice Address - Fax:808-521-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54952Medicare ID - Type UnspecifiedMEDICARE GROUP ID