Island Eye Center
Organization Active NPI Ophthalmology Physician · Tamuning, GU
NPI 1487772000 · NPPES record last updated Jul 13, 2020
Key facts
- NPI
- 1487772000
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- ISLAND EYE CENTER
- Practice address
- 415 Chalan San Antonio Ste 214
Tamuning, GU 96913-3620 - Phone
- (671) 647-5381
- Fax
- (671) 647-5385
- NPI assigned
- Mar 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Melissa Reyes Nucum
- Title
- GM/Coo
- Phone
- (671) 647-6213
Practitioners 8
-
Robert Stephen Jack, M.D.
-
Luke Tae Jong Moore, M.D.
-
Blake H Horio, MD
-
Eyal Margalit, MD, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GU
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040116000210 | GU | Part B Supplier - Clinic/Group Practice | 3375444920 |
Receives reassigned benefits from 5 practitioners Practice locations: Tamuning, GU |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | Yes |
Addresses
Primary practice location
415 Chalan San Antonio Ste 214
Tamuning, GU 96913-3620
Mailing address
415 214 Chalan San Antonio
Tamuning, GU 96913
Phone (671) 647-5381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| I0096079 | Medicaid | GU |
Other names
- Island Eye Institute
Other providers in Tamuning, GU
- Intercapital Inc.
- Lucy Marie Cruz Iona
- Isla Home Infusion Inc.
- Isla Pediatrics, PC
- Island Cancer Center Corporation
- Island Medical Specialists PC
- Ariel Arceo Ismael
- Wilaiwan Iyakraisorn
- J P Malilay DDS PC
- Jake Enterprises Inc
All providers in Tamuning, GU · Ophthalmology Physician in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.