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General NPI Number Information
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NPI Number | 1619118718
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Entity Type | Organization
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Legal Business Name | MAEHARA EYE SURGERY & LASER LLC
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 94-239 WAIPAHU DEPOT STREET #105
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City | WAIPAHU
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State | HI
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Zip | 96797-3095
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Country | US
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Telephone | 808-671-3782
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Fax | 808-671-3782
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Provider Business Mailing Address
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Address Line | 94-239 WAIPAHU DEPOT STREET #105
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City | WAIPAHU
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State | HI
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Zip | 96797-3095
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Country | US
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Telephone | 808-671-3782
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Fax | 808-671-3782
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS I MAEHARA
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Credential | M.D.
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Telephone | 808-671-3782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD-11924
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD-2131
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License Number State | HI
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