Provider Demographics
NPI:1851581268
Name:EYEWEAR KAHALA LLC
Entity Type:Organization
Organization Name:EYEWEAR KAHALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JYOJI
Authorized Official - Last Name:NIIMI
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:808-737-7973
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE 8070
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5306
Mailing Address - Country:US
Mailing Address - Phone:808-737-7973
Mailing Address - Fax:808-737-7974
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 8070
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5306
Practice Address - Country:US
Practice Address - Phone:808-737-7973
Practice Address - Fax:808-737-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-82332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5600130001Medicare NSC