NPIMap

Organization Active NPI

Aloha Eye Clinic Surgical Center LLC

  • Ambulatory Surgical Clinic/Center
  • Wailuku, HI
National Provider Identifier
1669868600
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ALOHA EYE CLINIC SURGICAL CENTER LLC
Practice address
450 Hookahi Street
Wailuku, HI 96793
Phone
(808) 877-3984
Fax
(808) 871-6498
NPI assigned
Apr 7, 2015
Last updated
Apr 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Authorized official

Name
Jivin Gerard Tantisira, MDNPI 1104889583
Title
Member
Phone
(808) 877-3984

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

450 Hookahi Street
Wailuku, HI 96793

Mailing address

450 Hookahi Street
Wailuku, HI 96793
Phone (808) 877-3984

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160415000050 HI Part B Supplier - Ambulatory Surgical Center 2365740966 Receives reassigned benefits from 3 practitioners
Practice locations: Wailuku, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669868600. Details of each certification follow.

Ambulatory surgical center certification: CCN 12C0001025

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ALOHA EYE CLINIC SURGICAL CENTER, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jun 10, 2016
Last certification
Jun 10, 2016
Ownership / control type
Proprietary
Facility address
450 Hookahi Street
Wailuku, HI 96793

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1669868600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 HOOKAHI STREET",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "96793",
            "telephone_number": "808-877-3984",
            "fax_number": "808-871-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 HOOKAHI STREET",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "96793",
            "telephone_number": "808-877-3984",
            "fax_number": "808-871-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALOHA EYE CLINIC SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "TANTISIRA",
        "authorized_official_first_name": "JIVIN",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "808-877-3984",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

Verify at the official NPI Registry.