Provider Demographics
NPI:1003138900
Name:CONSULTORES OFTALMICOS DEL SUR
Entity Type:Organization
Organization Name:CONSULTORES OFTALMICOS DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-7030
Mailing Address - Street 1:2225 EDIFICIO PARRA SUITE 802
Mailing Address - Street 2:PONCE BY PASS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1322
Mailing Address - Country:US
Mailing Address - Phone:787-841-7030
Mailing Address - Fax:787-844-1125
Practice Address - Street 1:2225 EDIFICIO PARRA SUITE 802
Practice Address - Street 2:PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1322
Practice Address - Country:US
Practice Address - Phone:787-841-7030
Practice Address - Fax:787-844-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center