Healthcare Provider Details

I. General information

NPI: 1639114846
Provider Name (Legal Business Name): GARY EDWARDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 806
HONOLULU HI
96813-2435
US

IV. Provider business mailing address

1329 LUSITANA ST STE 806
HONOLULU HI
96813-2435
US

V. Phone/Fax

Practice location:
  • Phone: 808-526-0030
  • Fax: 808-521-2823
Mailing address:
  • Phone: 808-526-0030
  • Fax: 808-521-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY A EDWARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-526-0030