Provider Demographics
NPI:1942505151
Name:LOUIE, MICHELLE JANE (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JANE
Last Name:LOUIE
Suffix:
Gender:F
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:PO BOX 31000
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96849-5717
Mailing Address - Country:US
Mailing Address - Phone:808-674-3913
Mailing Address - Fax:808-674-3914
Practice Address - Street 1:4589 KAPOLEI PKWY
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1879
Practice Address - Country:US
Practice Address - Phone:808-674-3913
Practice Address - Fax:808-674-3914
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14109152W00000X
HI738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist