Healthcare Provider Details

I. General information

NPI: 1487928750
Provider Name (Legal Business Name): HALE MAKA IKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 ALA MOANA BLVD SUITE 500
HONOLULU HI
96815-1437
US

IV. Provider business mailing address

PO BOX 1300 MAILCODE 61289
HONOLULU HI
96807-1300
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-0255
  • Fax: 808-955-4155
Mailing address:
  • Phone: 808-955-0255
  • Fax: 808-955-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D. BENNETT
Title or Position: PRESIDENT
Credential: MD
Phone: 808-955-0255