Provider Demographics
NPI:1689774408
Name:DURHAM-WORTHINGTON, JANICE J (OD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:J
Last Name:DURHAM-WORTHINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:J
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:94-1480 MOANIANI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4632
Mailing Address - Country:US
Mailing Address - Phone:808-432-3100
Mailing Address - Fax:
Practice Address - Street 1:94-1480 MOANIANI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4632
Practice Address - Country:US
Practice Address - Phone:808-432-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI041348-02Medicaid
HI0000045492OtherHMSA BILLING NUMBER
HIT95361Medicare UPIN
HIH0000PGBHPMedicare PIN