Healthcare Provider Details

I. General information

NPI: 1619118825
Provider Name (Legal Business Name): PACIFIC RETINA CARE. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-849 LUMIAINA ST SUITE 102
WAIPAHU HI
96797-5025
US

IV. Provider business mailing address

94-849 LUMIAINA ST SUITE 102
WAIPAHU HI
96797-5025
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-4772
  • Fax: 808-676-8772
Mailing address:
  • Phone: 808-676-4772
  • Fax: 808-676-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD 11913
License Number StateHI

VIII. Authorized Official

Name: DR. MARK EDWARD TAFOYA
Title or Position: OWNER
Credential: M.D.
Phone: 808-676-4772