Provider Demographics
NPI:1285722694
Name:ALOHA FAMILY OPTOMETRIC GROUP
Entity type:Organization
Organization Name:ALOHA FAMILY OPTOMETRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:IDETA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-226-3937
Mailing Address - Street 1:7215 N 1ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2985
Mailing Address - Country:US
Mailing Address - Phone:559-226-3937
Mailing Address - Fax:559-226-8305
Practice Address - Street 1:7215 N 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2985
Practice Address - Country:US
Practice Address - Phone:559-226-3937
Practice Address - Fax:559-226-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0686320001Medicare NSC