Healthcare Provider Details

I. General information

NPI: 1740065325
Provider Name (Legal Business Name): ALOHA EYE CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N HOLOPONO ST STE 109
KIHEI HI
96753-6946
US

IV. Provider business mailing address

PO BOX 29960
HONOLULU HI
96820-2360
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-3984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JIVIN GERARD TANTISIRA
Title or Position: OWNER
Credential:
Phone: 808-877-3984