Provider Demographics
NPI:1891891164
Name:PACIFIC EYE CENTER, INC
Entity Type:Organization
Organization Name:PACIFIC EYE CENTER, INC
Other - Org Name:PACIFIC EYE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-245-5377
Mailing Address - Street 1:4418 KUKUI GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1676
Mailing Address - Country:US
Mailing Address - Phone:808-245-5377
Mailing Address - Fax:808-245-6142
Practice Address - Street 1:4418 KUKUI GROVE STREET
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1676
Practice Address - Country:US
Practice Address - Phone:808-245-5377
Practice Address - Fax:808-245-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05516401Medicaid
HI05516401Medicaid
100093Medicare PIN