Provider Demographics
NPI:1376339986
Name:PROJECT VISION HAWAII
Entity type:Organization
Organization Name:PROJECT VISION HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATHSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-430-0388
Mailing Address - Street 1:PO BOX 23212
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3212
Mailing Address - Country:US
Mailing Address - Phone:808-201-3937
Mailing Address - Fax:833-941-2390
Practice Address - Street 1:200 N VINEYARD BLVD STE B-120
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3950
Practice Address - Country:US
Practice Address - Phone:808-201-3937
Practice Address - Fax:833-941-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000068Medicaid