Provider Demographics
NPI:1912928367
Name:HAWAII VISION CLINIC INC
Entity Type:Organization
Organization Name:HAWAII VISION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-487-7938
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:STE 703
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3978
Mailing Address - Country:US
Mailing Address - Phone:808-487-7938
Mailing Address - Fax:808-485-8022
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:STE 703
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3978
Practice Address - Country:US
Practice Address - Phone:808-487-7938
Practice Address - Fax:808-485-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10426305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH100464Medicare PIN
HI5713610001Medicare NSC