Healthcare Provider Details

I. General information

NPI: 1174610927
Provider Name (Legal Business Name): DIANE J. WRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 KUKUI GROVE ST
LIHUE HI
96766
US

IV. Provider business mailing address

4418 KUKUI GROVE ST
LIHUE HI
96766
US

V. Phone/Fax

Practice location:
  • Phone: 808-245-5377
  • Fax: 808-245-6142
Mailing address:
  • Phone: 808-245-5377
  • Fax: 808-245-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD13010
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: