MEDICARE: HAWAII VISION CLINIC INC

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	305R00000X	Preferred Provider Organization	MD10426	HI

General Provider Information

NPI Number	:	1912928367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWAII VISION CLINIC INC

Provider Business Mailing Address
First Line	:	99-128 AIEA HEIGHTS DR
Second Line	:	STE 703
City	:	AIEA
State	:	HI
Zip	:	96701-3978
Country	:	US
Telephone Number	:	808-487-7938
Fax Number	:	808-485-8022

Provider Business Practice Location Address
First Line	:	99-128 AIEA HEIGHTS DR
Second Line	:	STE 703
City	:	AIEA
State	:	HI
Zip	:	96701-3978
Country	:	US
Telephone Number	:	808-487-7938
Fax Number	:	808-485-8022

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. NORA I CORPUZ
Credential	:
Telephone Number	:	808-487-7938

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/10/2008

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