NPIMap

Organization Active NPI

Garden Island Eye Care

  • Optometrist
  • Lihue, HI
National Provider Identifier
1962706473
Registry record updated Oct 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD674 Issued in HI
Legal business name
GARDEN ISLAND EYE CARE
Doing business as
Garden Island Eye Care
Practice address
4414 Kukui Grove Street
Suite 101
Lihue, HI 96766
Phone
(808) 632-2020
NPI assigned
Dec 28, 2010
Last updated
Oct 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2017

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

Authorized official

Name
Dr. Derelyne Gandia, O.D.NPI 1871781153
Title
Optometrist
Phone
(808) 632-2020

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
Optometrist 152W00000X OD674 HI Primary

Addresses

Primary practice location

4414 Kukui Grove Street
Suite 101
Lihue, HI 96766

Mailing address

4414 Kukui Grove Street
Suite 101
Lihue, HI 96766
Phone (808) 632-2020

Other identifiers 1

IdentifierTypeStateIssuer
613001-01MedicaidHI

Other names 1

  • Garden Island Eye Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110225000795 HI Part B Supplier - Clinic/Group Practice 9335320175 Receives reassigned benefits from 1 practitioner
Practice locations: Lihue, HI

National Provider Directory

National Provider Directory

Locations

4414 Kukui Grove St
Ste 101
Lihue, HI 96766
Phone (808) 632-2020

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1962706473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4414 KUKUI GROVE STREET",
            "address_2": "SUITE 101",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "96766",
            "telephone_number": "808-632-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 KUKUI GROVE STREET",
            "address_2": "SUITE 101",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "96766",
            "telephone_number": "808-632-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN ISLAND EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "GANDIA",
        "authorized_official_first_name": "DERELYNE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "808-632-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "HI",
            "license": "OD674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "613001-01",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden Island Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lihue, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.