Basic Information
| Provider Information | |||||||||
| NPI: | 1164048005 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCULOFACIAL PLASTIC SURGERY OF HAWAII INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1300 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968071300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088889981 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1380 LUSITANA ST STE 912 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088889981 | ||||||||
| FaxNumber: | 8084684753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | BRADFORD | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8088889981 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.