MEDICARE: ISLAND EYE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487772000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND EYE CENTER

Provider Business Mailing Address
First Line	:	415 214 CHALAN SAN ANTONIO
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-647-5381
Fax Number	:	671-647-5385

Provider Business Practice Location Address
First Line	:	415 CHALAN SAN ANTONIO STE 214
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913-3620
Country	:	US
Telephone Number	:	671-647-5381
Fax Number	:	671-647-5385

Authorized Official
Title or Position	:	GM/COO
Name	:	MS. MELISSA REYES NUCUM
Credential	:
Telephone Number	:	671-647-6213

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/13/2020

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Directions to “ISLAND EYE CENTER ” Practice Location

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