Provider Demographics
NPI:1659328334
Name:RETINA CENTER OF HAWAII LLC
Entity Type:Organization
Organization Name:RETINA CENTER OF HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ATABARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-550-8440
Mailing Address - Street 1:1380 LUSITANA STREET
Mailing Address - Street 2:STE 201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-550-8440
Mailing Address - Fax:808-550-8488
Practice Address - Street 1:1380 LUSITANA STREET
Practice Address - Street 2:STE 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-550-8440
Practice Address - Fax:808-550-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 9729207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08089302Medicaid
HIA210904OtherHMSA
HIH55873Medicare ID - Type Unspecified
HI08089302Medicaid