1114199726 NPI number — HONOLULU VISION CENTER, INC.

Table of content: KATELYN DIANE JOHN RDN, LD (NPI 1689272965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114199726 NPI number — HONOLULU VISION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HONOLULU VISION CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114199726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 PIIKOI ST STE 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 PIIKOI ST STE 1510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-593-2377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
PEILI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-593-2377

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  HI498 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B222832 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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