Provider Demographics
NPI:1336371327
Name:MAUI OPTIX LLC
Entity Type:Organization
Organization Name:MAUI OPTIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-214-9074
Mailing Address - Street 1:PO BOX 29690
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2090
Mailing Address - Country:US
Mailing Address - Phone:808-214-9074
Mailing Address - Fax:808-214-9071
Practice Address - Street 1:24 KIOPAA PL STE 102
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8295
Practice Address - Country:US
Practice Address - Phone:808-214-9074
Practice Address - Fax:808-214-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HICJ445AMedicare PIN