=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285870832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADISE EYEWEAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2009
-----------------------------------------------------
Last Update Date | 02/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1413 S KING ST STE 203
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-955-3532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1413 S KING ST STE 203
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-955-3532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. BEVERLY TAKABAYASHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-395-3898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------