Healthcare Provider Details

I. General information

NPI: 1750397014
Provider Name (Legal Business Name): RETINA CENTER OF GUAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RETINA CENTER OF GUAM, LLC 633 GOVERNOR CARLOS CAMACHO RD, SUITE 205
TAMUNING GU
96913
US

IV. Provider business mailing address

2055 N KING ST STE 100
HONOLULU HI
96819-3462
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-7400
  • Fax: 808-521-7798
Mailing address:
  • Phone: 808-533-7400
  • Fax: 808-521-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. M. PIERRE PANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-533-7400