Provider Demographics
NPI:1750397014
Name:RETINA CENTER OF GUAM, LLC
Entity type:Organization
Organization Name:RETINA CENTER OF GUAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M. PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-533-7400
Mailing Address - Street 1:2055 N KING ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3462
Mailing Address - Country:US
Mailing Address - Phone:808-533-7400
Mailing Address - Fax:808-521-7798
Practice Address - Street 1:RETINA CENTER OF GUAM, LLC
Practice Address - Street 2:633 GOVERNOR CARLOS CAMACHO RD, SUITE 205
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:808-533-7400
Practice Address - Fax:808-521-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH54658Medicare ID - Type Unspecified