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General NPI Number Information
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NPI Number | 1043376742
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Entity Type | Organization
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Legal Business Name | EYEWEAR KONA INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 75167 HUALALAI ROAD
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City | KAILUA KONA
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State | HI
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Zip | 96740
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Country | US
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Telephone | 808-329-9308
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Fax | 808-329-9309
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Provider Business Mailing Address
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Address Line | PO BOX 640 75167 HUALALAI ROAD
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City | KAILUA KONA
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State | HI
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Zip | 96745
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Country | US
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Telephone | 808-329-9308
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Fax | 808-329-9309
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALVIN TSUYOSHI FUJIMOTO
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Credential | OPTICIAN
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Telephone | 808-329-9308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DIO91
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License Number State | HI
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