MEDICARE: PEARL HARBOR VISION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	498	HI

General Provider Information

NPI Number	:	1043356884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL HARBOR VISION CENTER

Provider Business Mailing Address
First Line	:	1025 QUINCY AVE
Second Line	:	SUITE 1020
City	:	PEARL HARBOR
State	:	HI
Zip	:	96860-4512
Country	:	US
Telephone Number	:	808-422-2210
Fax Number	:	808-422-2262

Provider Business Practice Location Address
First Line	:	4725 BOUGAINVILLE DR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3179
Country	:	US
Telephone Number	:	808-422-2210
Fax Number	:	808-422-2262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PEILI LIN
Credential	:	O.D.
Telephone Number	:	808-422-2210

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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