Provider Demographics
NPI:1912789462
Name:MARQUEZ, MATTHEW (DIO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:DIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-279 WAIMAKUA DR
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3241
Mailing Address - Country:US
Mailing Address - Phone:808-393-3443
Mailing Address - Fax:
Practice Address - Street 1:95-550 LANIKUHANA AVE
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1783
Practice Address - Country:US
Practice Address - Phone:808-623-9200
Practice Address - Fax:808-623-9677
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI360156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician