Garden Island Eye Care
Organization Active NPI Optometrist · Lihue, HI
NPI 1962706473 · NPPES record last updated Oct 18, 2017
Key facts
- NPI
- 1962706473
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OD674 (HI)
- Legal business name
- GARDEN ISLAND EYE CARE
- Practice address
- 4414 Kukui Grove Street
Suite 101
Lihue, HI 96766 - Phone
- (808) 632-2020
- NPI assigned
- Dec 28, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Derelyne Gandia, O.D.
- Title
- Optometrist
- Phone
- (808) 632-2020
Practitioners 2
-
Glenn Paul Belisle, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110225000795 | HI | Part B Supplier - Clinic/Group Practice | 9335320175 |
Receives reassigned benefits from 1 practitioner Practice locations: Lihue, HI |
National Provider Directory
Locations
4414 Kukui Grove St
Ste 101
Lihue, HI 96766
Phone (808) 632-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OD674 | HI | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 613001-01 | Medicaid | HI |
Other names
- Garden Island Eye Care
Other providers in Lihue, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.