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General NPI Number Information
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NPI Number | 1629280284
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Entity Type | Organization
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Legal Business Name | PACIFIC EYEWEAR INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 4418 KUKUI GROVE ST
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City | LIHUE
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State | HI
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Zip | 96766-1676
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Country | US
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Telephone | 808-245-5377
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Fax | 808-245-6142
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Provider Business Mailing Address
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Address Line | 4418 KUKUI GROVE ST
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City | LIHUE
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State | HI
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Zip | 96766-1676
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Country | US
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Telephone | 808-245-5377
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Fax | 808-245-6142
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY SHERRER
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Credential | M.D.
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Telephone | 808-245-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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