Provider Demographics
NPI:1740065325
Name:ALOHA EYE CLINIC, LTD.
Entity type:Organization
Organization Name:ALOHA EYE CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIVIN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:TANTISIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-877-3984
Mailing Address - Street 1:PO BOX 29960
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 N HOLOPONO ST STE 109
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6946
Practice Address - Country:US
Practice Address - Phone:808-877-3984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty