Healthcare Provider Details

I. General information

NPI: 1437165396
Provider Name (Legal Business Name): CARLOS A. OMPHROY M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-720 LANIKUHANA AVE SUITE 110
MILILANI HI
96789-2985
US

IV. Provider business mailing address

95-720 LANIKUHANA AVE SUITE 110
MILILANI HI
96789-2985
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-5577
  • Fax: 808-625-1221
Mailing address:
  • Phone: 808-625-5577
  • Fax: 808-625-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD4936
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: