MEDICARE: DR. TIMOTHY H MOON O.D.

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	OD 450	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	94-3274533	OTHER	HI	FEDERAL TAX ID
3	A20813-0	OTHER	HI	HMSA QUEST
4	A20813-0	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1245383504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY H MOON O.D.

Provider Business Mailing Address
First Line	:	1441 KAPIOLANI BLVD
Second Line	:	SUITE 312
City	:	HONOLULU
State	:	HI
Zip	:	96814-4402
Country	:	US
Telephone Number	:	808-946-7700
Fax Number	:	808-946-7710

Provider Business Practice Location Address
First Line	:	1441 KAPIOLANI BLVD
Second Line	:	SUITE 312
City	:	HONOLULU
State	:	HI
Zip	:	96814-4402
Country	:	US
Telephone Number	:	808-946-7700
Fax Number	:	808-946-7710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	06/02/2026

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Directions to “ DR. TIMOTHY H MOON O.D.” Practice Location

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