Organization
PREMIER VISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLLEEN MARIKO ICHIYAMA-KONG O.D. (OPTOMETRIST)
(808) 244-8034
Entity
Organization
Contact information
Practice address
2049 WELLS ST, SUITE #1, WAILUKU, HI 96793-2239
(808) 244-8034
(808) 244-8035
Mailing address
2049 WELLS ST, SUITE #1, WAILUKU, HI 96793-2239
(808) 244-8034
(808) 244-8035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD478
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50181803
—
HI
Enumeration date
01/24/2007
Last updated
10/24/2007
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