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General NPI Number Information
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NPI Number | 1639816986
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Entity Type | Organization
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Legal Business Name | AVENOIR LLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 111 AUPUNI ST STE 101
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City | HILO
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State | HI
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Zip | 96720-4233
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Country | US
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Telephone | 808-935-2964
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Fax |
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Provider Business Mailing Address
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Address Line | 1777 S BURLINGTON BLVD # 264
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City | BURLINGTON
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State | WA
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Zip | 98233-3223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WENDY SIAPCO
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Credential |
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Telephone | 360-630-1512
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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 |
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License Number State |
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