Provider Demographics
NPI:1487772000
Name:ISLAND EYE CENTER
Entity type:Organization
Organization Name:ISLAND EYE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GM/COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:NUCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-647-6213
Mailing Address - Street 1:415 214 CHALAN SAN ANTONIO
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-5381
Mailing Address - Fax:671-647-5385
Practice Address - Street 1:415 CHALAN SAN ANTONIO STE 214
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3620
Practice Address - Country:US
Practice Address - Phone:671-647-5381
Practice Address - Fax:671-647-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUI0096079Medicaid
GU50870Medicare ID - Type Unspecified