Healthcare Provider Details

I. General information

NPI: 1467075721
Provider Name (Legal Business Name): MRS HILO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W KAWAILANI ST
HILO HI
96720-5649
US

IV. Provider business mailing address

34 W KAWAILANI ST
HILO HI
96720-5649
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-8887
  • Fax:
Mailing address:
  • Phone: 808-935-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RAGHAV GARG
Title or Position: MANAGER
Credential:
Phone: 808-935-8887