Provider Demographics
NPI:1023524378
Name:ISLAND GIRL EYECARE INC
Entity type:Organization
Organization Name:ISLAND GIRL EYECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-225-2883
Mailing Address - Street 1:417 ULUNIU ST STE E
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2551
Mailing Address - Country:US
Mailing Address - Phone:808-261-5555
Mailing Address - Fax:
Practice Address - Street 1:417 ULUNIU ST STE E
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2551
Practice Address - Country:US
Practice Address - Phone:808-261-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1447216569OtherPERSONAL NPI
HIOD393OtherOPTOMETRY LICENSE