Provider Demographics
NPI:1922185503
Name:CAMBLOR, ANGEL A (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:A
Last Name:CAMBLOR
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 1:479 MILILANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4326
Mailing Address - Country:US
Mailing Address - Phone:808-935-1111
Mailing Address - Fax:
Practice Address - Street 1:479 MILILANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4326
Practice Address - Country:US
Practice Address - Phone:808-935-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIOD-257OtherVISION SERVICE PLAN
HI05649501Medicaid
HIP93088Medicare UPIN
HI0000PGBJFMedicare ID - Type UnspecifiedMEDICARE