Provider Demographics
NPI:1740300623
Name:LIN, PAUL R (OD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:LIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 KEEAUMOKU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3014
Mailing Address - Country:US
Mailing Address - Phone:808-949-3937
Mailing Address - Fax:808-955-8526
Practice Address - Street 1:700 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3014
Practice Address - Country:US
Practice Address - Phone:808-949-3937
Practice Address - Fax:808-955-8526
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB 18313OtherHMSA
HIT41195Medicare UPIN