Provider Demographics
NPI:1215969290
Name:MAUI EYE CENTER LLC
Entity type:Organization
Organization Name:MAUI EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGANING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-871-7874
Mailing Address - Street 1:275 W KAAHUMANU AVE STE 1000
Mailing Address - Street 2:C/O SEARS OPTICAL
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1612
Mailing Address - Country:US
Mailing Address - Phone:808-877-2262
Mailing Address - Fax:
Practice Address - Street 1:275 W KAAHUMANU AVE STE 1000
Practice Address - Street 2:C/O SEARS OPTICAL
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1612
Practice Address - Country:US
Practice Address - Phone:808-877-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIV08298Medicare UPIN