Provider Demographics
NPI:1639433006
Name:DURAN, PHILLIP JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:DURAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:MAILCODE 61072
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-955-0255
Mailing Address - Fax:808-955-4155
Practice Address - Street 1:1620 ALA MOANA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1437
Practice Address - Country:US
Practice Address - Phone:808-955-0255
Practice Address - Fax:808-955-4155
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist