Provider Demographics
NPI:1215128673
Name:LUIS C OMPHROY MD LLC
Entity type:Organization
Organization Name:LUIS C OMPHROY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:OMPHROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-487-7700
Mailing Address - Street 1:98 1079 MOANALUA ROAD SUITE 680
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4713
Mailing Address - Country:US
Mailing Address - Phone:808-487-7700
Mailing Address - Fax:808-488-4151
Practice Address - Street 1:98 1079 MOANALUA ROAD SUITE 680
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-487-7700
Practice Address - Fax:808-488-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52688204Medicaid
HIH100388Medicare PIN
HI5937980001Medicare NSC