Healthcare Provider Details

I. General information

NPI: 1427005644
Provider Name (Legal Business Name): BIG ISLAND VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 ULULANI ST A
HILO HI
96720
US

IV. Provider business mailing address

899-A ULULANI STREET
HILO HI
96720
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-3937
  • Fax: 808-935-3882
Mailing address:
  • Phone: 808-935-3937
  • Fax: 808-935-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD320
License Number StateHI

VIII. Authorized Official

Name: CEDRIC MITSUI
Title or Position: PRESIDENT
Credential: OD
Phone: 808-935-3937