Provider Demographics
NPI:1003969353
Name:CAYEY VISUAL CENTER, CORP
Entity Type:Organization
Organization Name:CAYEY VISUAL CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:DIAZ HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-263-1335
Mailing Address - Street 1:4 CALLE MADRESELVA
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4879
Mailing Address - Country:US
Mailing Address - Phone:787-402-4739
Mailing Address - Fax:787-263-1335
Practice Address - Street 1:5001 AVE JESUS T PINERO STE 130
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5541
Practice Address - Country:US
Practice Address - Phone:787-263-1335
Practice Address - Fax:787-263-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR621305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSOCIAL SECURITY