1194867770 NPI number — PARADISE OPTICAL CO., INC.

Table of content: (NPI 1194867770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194867770 NPI number — PARADISE OPTICAL CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADISE OPTICAL CO., 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:
1194867770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98-1277 KAAHUMANU ST.
Provider Second Line Business Mailing Address:
#105
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-488-6869
Provider Business Mailing Address Fax Number:
808-488-6869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-1277 KAAHUMANU ST.
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-6869
Provider Business Practice Location Address Fax Number:
808-488-6869
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHOY
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
J.F.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
808-488-6869

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A59681 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000059683 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0059681 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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