Healthcare Provider Details

I. General information

NPI: 1215775440
Provider Name (Legal Business Name): ASHLEY JAMES KUCERA LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-595 KUPUOHI ST
WAIPAHU HI
96797-5382
US

IV. Provider business mailing address

459 PORTLOCK RD
HONOLULU HI
96825-2000
US

V. Phone/Fax

Practice location:
  • Phone: 808-688-0700
  • Fax: 808-688-1615
Mailing address:
  • Phone: 808-927-5348
  • Fax: 808-396-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDIO-292
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: