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Organization Active NPI

Kalihi-Palama Health Center Optometry

  • Optometrist
  • Honolulu, HI
National Provider Identifier
1609818749
Registry record updated Aug 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KALIHI-PALAMA HEALTH CENTER OPTOMETRY
Practice address
888 N King St
Honolulu, HI 96817-4553
Phone
(808) 841-2791
NPI assigned
Jun 12, 2006
Organization subpart
Yes
Parent organization
KALIHI-PALAMA HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victoria Kay Lancaster
Title
Patient Accounting Manager
Phone
(808) 843-7239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

888 N King St
Honolulu, HI 96817-4553

Mailing address

915 N King St
Honolulu, HI 96817-4544
Phone (808) 841-2791

Other identifiers 1

IdentifierTypeStateIssuer
51863101MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060309000345 HI Part A Provider - Federally Qualified Health Center (FQHC) 4284544842 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Honolulu, HI

Federally qualified health center certification: CCN 121803

Legal name
KALIHI PALAMA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 19, 1993
Last certification
Jul 19, 1993
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1975 in HI
Enrollment address
915 N King St
Honolulu, HI 96817-4544

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Kalihi-Palama Health Center Optometry

Locations

888 N King St
Honolulu, HI 96817
Phone (808) 792-5559

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mattlie Davis Individual Corporate DirectorBoard Member Sep 21, 2011
Christopher Pating Individual Corporate DirectorBoard Member Feb 16, 2011
Emmanuel Kintu Individual Corporate OfficerCeo/Executive Director Apr 24, 2005
W-2 Managing EmployeeCeo/Executive Director Apr 24, 2005 100%
Russell Kaupu Individual Corporate DirectorBoard Member Feb 16, 2011
Liane L Sugimoto Individual Corporate OfficerCfo/Chief Financial Officer Mar 8, 2010
Darrin Sato Individual Corporate OfficerCoo/Chief Operation Officer Apr 24, 2005
Rosemarie V Mendoza Individual Corporate DirectorBoard Member May 13, 2009
Vernon Y Nakamura Individual Corporate OfficerBoard President Dec 8, 2011
Peter K Hanashiro Individual Corporate OfficerTreasurer of the Board Dec 8, 2011
Clifford Chang Individual Corporate DirectorBoard Member Jul 12, 2000
Siu Lo L Li Individual Corporate OfficerSecretary PF the Board Dec 8, 2011
Dawn Hirai Individual Corporate DirectorBoard Member Jan 1, 2008

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186444800000",
    "number": "1609818749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968174544",
            "telephone_number": "808-841-2791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 N KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968174553",
            "telephone_number": "808-841-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALIHI-PALAMA HEALTH CENTER OPTOMETRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KALIHI-PALAMA HEALTH CENTER",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-08-07",
        "status": "A",
        "authorized_official_last_name": "LANCASTER",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PATIENT ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "808-843-7239"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51863101",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.