Healthcare Provider Details

I. General information

NPI: 1528121423
Provider Name (Legal Business Name): LUIS CARLOS OMPHROY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD SUITE 680
AIEA HI
96701-4713
US

IV. Provider business mailing address

98-1079 MOANALUA RD SUITE 680
AIEA HI
96701-4713
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-7700
  • Fax: 808-488-4151
Mailing address:
  • Phone: 808-487-7700
  • Fax: 808-488-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD11461
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-11461
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: