Provider Demographics
NPI:1447298344
Name:ALOHA EYE CLINIC, LTD.
Entity type:Organization
Organization Name:ALOHA EYE CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTISIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-877-3984
Mailing Address - Street 1:PO BOX 29960
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2360
Mailing Address - Country:US
Mailing Address - Phone:808-877-3984
Mailing Address - Fax:808-871-6498
Practice Address - Street 1:450 HOOKAHI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1474
Practice Address - Country:US
Practice Address - Phone:808-877-3984
Practice Address - Fax:808-871-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-809152W00000X
HIMD-9427207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00264901Medicaid
HI00264901Medicaid