Provider Demographics
NPI:1992727499
Name:HIGUCHI, CARLYS MALIA REI (OD)
Entity type:Individual
Prefix:MISS
First Name:CARLYS
Middle Name:MALIA REI
Last Name:HIGUCHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 KIOPAA PL
Mailing Address - Street 2:STE 102
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8295
Mailing Address - Country:US
Mailing Address - Phone:808-214-9074
Mailing Address - Fax:
Practice Address - Street 1:8 KIOPAA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8283
Practice Address - Country:US
Practice Address - Phone:808-214-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIV10753Medicare UPIN