Provider Demographics
NPI:1396789665
Name:GLAUCOMA CENTER OF HAWAII, LLC
Entity type:Organization
Organization Name:GLAUCOMA CENTER OF HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:808-945-2222
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4401
Mailing Address - Country:US
Mailing Address - Phone:808-945-2222
Mailing Address - Fax:808-945-2220
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1403
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4401
Practice Address - Country:US
Practice Address - Phone:808-945-2222
Practice Address - Fax:808-945-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H101534Medicare PIN