Provider Demographics
NPI:1720463607
Name:BABIN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BABIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 PILI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3943
Mailing Address - Country:US
Mailing Address - Phone:808-561-9000
Mailing Address - Fax:
Practice Address - Street 1:1450 ALA MOANA BLVD STE 1226
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4610
Practice Address - Country:US
Practice Address - Phone:808-947-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician