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General NPI Number Information
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NPI Number | 1487928750
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Entity Type | Organization
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Legal Business Name | HALE MAKA IKE LLC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 1620 ALA MOANA BLVD SUITE 500
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City | HONOLULU
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State | HI
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Zip | 96815-1437
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Country | US
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Telephone | 808-955-0255
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Fax | 808-955-4155
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Provider Business Mailing Address
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Address Line | PO BOX 1300 MAILCODE 61289
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City | HONOLULU
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State | HI
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Zip | 96807-1300
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Country | US
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Telephone | 808-955-0255
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Fax | 808-955-4155
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL D. BENNETT
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Credential | MD
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Telephone | 808-955-0255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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