Provider Demographics
NPI:1841205549
Name:VISHER, KENT C (O D)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:C
Last Name:VISHER
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-625-5577
Mailing Address - Fax:808-625-1221
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-625-5577
Practice Address - Fax:808-625-1221
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00E020060-9OtherHMSA
HI070190Medicaid
HI070190Medicaid
HI101109Medicare PIN