Provider Demographics
NPI:1174367122
Name:TEAL, MAIKA (OD)
Entity type:Individual
Prefix:
First Name:MAIKA
Middle Name:
Last Name:TEAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-718 PUAMOHALA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2449
Mailing Address - Country:US
Mailing Address - Phone:808-387-3005
Mailing Address - Fax:
Practice Address - Street 1:1620 ALA MOANA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1437
Practice Address - Country:US
Practice Address - Phone:808-955-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-1042-0152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist