Provider Demographics
NPI:1942341466
Name:LIN EYE SURGERY & LASER CENTER LLC
Entity Type:Organization
Organization Name:LIN EYE SURGERY & LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-946-7889
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1488
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4471
Mailing Address - Country:US
Mailing Address - Phone:808-946-7889
Mailing Address - Fax:808-946-7880
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 1488
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4471
Practice Address - Country:US
Practice Address - Phone:808-946-7889
Practice Address - Fax:808-946-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6271450001OtherDMERC SUPPLIED ID #
6271450001OtherDMERC SUPPLIED ID #
6271450001Medicare NSC
HI=========OtherTAX ID#