Provider Demographics
NPI:1730229345
Name:LAU, KHAN (OD)
Entity type:Individual
Prefix:DR
First Name:KHAN
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 KAPIOLANI BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3878
Mailing Address - Country:US
Mailing Address - Phone:808-941-1566
Mailing Address - Fax:808-947-4499
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3878
Practice Address - Country:US
Practice Address - Phone:808-941-1566
Practice Address - Fax:808-947-4499
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI309152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH100934Medicare ID - Type UnspecifiedID NUMBER