Healthcare Provider Details

I. General information

NPI: 1447298344
Provider Name (Legal Business Name): ALOHA EYE CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/29/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 HOOKAHI ST
WAILUKU HI
96793-1474
US

IV. Provider business mailing address

PO BOX 29960
HONOLULU HI
96820-2360
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-3984
  • Fax: 808-871-6498
Mailing address:
  • Phone: 801-845-2677
  • Fax: 808-871-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD-809
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD-9427
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-9427
License Number StateHI

VIII. Authorized Official

Name: JIVIN TANTISIRA
Title or Position: PRESIDENT
Credential: MD
Phone: 808-877-3984