Healthcare Provider Details

I. General information

NPI: 1902042757
Provider Name (Legal Business Name): FONG EYECARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 KAPIOLANI BLVD STE. C-204
HONOLULU HI
96813-6023
US

IV. Provider business mailing address

725 KAPIOLANI BLVD STE. C-204
HONOLULU HI
96813-6023
US

V. Phone/Fax

Practice location:
  • Phone: 808-593-8939
  • Fax:
Mailing address:
  • Phone: 808-593-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number187
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. RODNEY S.O. FONG
Title or Position: PRESIDENT
Credential: O.D.
Phone: 808-593-8939