Provider Demographics
NPI:1356581425
Name:MAEHARA EYE SURGERY & LASER LLC
Entity type:Organization
Organization Name:MAEHARA EYE SURGERY & LASER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ISSEI
Authorized Official - Last Name:MAEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-955-3937
Mailing Address - Street 1:1441 KAPIOLANI BLVD.
Mailing Address - Street 2:SUITE 1419
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4407
Mailing Address - Country:US
Mailing Address - Phone:808-955-3937
Mailing Address - Fax:808-955-3930
Practice Address - Street 1:1441 KAPIOLANI BLVD.
Practice Address - Street 2:SUITE 1419
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4407
Practice Address - Country:US
Practice Address - Phone:808-955-3937
Practice Address - Fax:808-955-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11924207W00000X
HIMD-2131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty