Provider Demographics
NPI:1487877403
Name:CARPENTER, RICK A (DO)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 AUPUNI ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4233
Mailing Address - Country:US
Mailing Address - Phone:808-935-2964
Mailing Address - Fax:808-961-6421
Practice Address - Street 1:111 AUPUNI ST STE 101
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-2964
Practice Address - Fax:808-961-6421
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-842207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25206401Medicaid
G54050Medicare UPIN
HI25206401Medicaid