Healthcare Provider Details

I. General information

NPI: 1386706414
Provider Name (Legal Business Name): MICHAEL K.H. ORIDE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170-B JERVES STREET
LIHUE HI
96766
US

IV. Provider business mailing address

3170-B JERVES STREET
LIHUE HI
96766
US

V. Phone/Fax

Practice location:
  • Phone: 808-245-8765
  • Fax: 808-245-8816
Mailing address:
  • Phone: 808-245-8765
  • Fax: 808-245-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number224
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: