Healthcare Provider Details

I. General information

NPI: 1639433006
Provider Name (Legal Business Name): PHILLIP JOSEPH DURAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 08/19/2014
Certification Date:
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 61072
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 Number1234
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: