Healthcare Provider Details

I. General information

NPI: 1063586741
Provider Name (Legal Business Name): JOEL ERNEST PUNZAL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4454 NUHOU ST
LIHUE HI
96766-8022
US

IV. Provider business mailing address

4454 NUHOU ST STE 513
LIHUE HI
96766-8022
US

V. Phone/Fax

Practice location:
  • Phone: 808-278-8383
  • Fax: 808-855-2004
Mailing address:
  • Phone: 88-278-8383
  • Fax: 808-855-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number607
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD-607
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: