Individual
DR. TIMOTHY H MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1441 KAPIOLANI BLVD, SUITE 312, HONOLULU, HI 96814-4402
(808) 946-7700
(808) 946-7710
Mailing address
1441 KAPIOLANI BLVD, SUITE 312, HONOLULU, HI 96814-4402
(808) 946-7700
(808) 946-7710
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD 450
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49451801
—
HI
01
—
94-3274533
FEDERAL TAX ID
HI
01
—
A20813-0
HMSA QUEST
HI
Enumeration date
01/19/2007
Last updated
08/05/2011
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