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General NPI Number Information
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NPI Number | 1366579468
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Entity Type | Organization
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Legal Business Name | PACIFIC EYE CENTER
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 562 HARMON LOOP RD STE D2
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City | DEDEDO
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State | GU
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Zip | 96929
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Country | US
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Telephone | 671-637-9889
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Fax | 671-632-5558
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Provider Business Mailing Address
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Address Line | 562 HARMON LOOP RD STE D2
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City | DEDEDO
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State | GU
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Zip | 96929
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Country | US
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Telephone | 671-637-9889
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Fax | 671-632-5558
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOEL MENDOZA DIZON
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Credential | OD
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Telephone | 671-637-9889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OL026
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License Number State | GU
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