| NPI | 1740065325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIVIN GERARD TANTISIRA Owner 808-877-3984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |