Provider Demographics
NPI:1528121423
Name:OMPHROY, LUIS CARLOS (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:CARLOS
Last Name:OMPHROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD
Mailing Address - Street 2:SUITE 680
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 RD
Practice Address - Street 2:SUITE 680
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11461174400000X
HIMD-11461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID0228777Medicaid
HI11461OtherMD
HI100388Medicare ID - Type Unspecified
HI100388Medicare UPIN