=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992759146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RETINA ASSOCIATES OF HAWAII, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 LUSITANA ST SUITE 502
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-521-8483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 LUSITANA ST SUITE 502
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-521-8483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JOHN HUEY DROUILHET
-----------------------------------------------------
Credential | M.D., F.A.C.S.
-----------------------------------------------------
Telephone | 808-521-8483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2509
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------