Healthcare Provider Details

I. General information

NPI: 1487772000
Provider Name (Legal Business Name): ISLAND EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CHALAN SAN ANTONIO STE 214
TAMUNING GU
96913-3620
US

IV. Provider business mailing address

415 214 CHALAN SAN ANTONIO
TAMUNING GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-5381
  • Fax: 671-647-5385
Mailing address:
  • Phone: 671-647-5381
  • Fax: 671-647-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA REYES NUCUM
Title or Position: GM/COO
Credential:
Phone: 671-647-6213