Provider Demographics
NPI:1013213446
Name:CENTRO OPTOMETRICO DRA MONTESINOS INC
Entity Type:Organization
Organization Name:CENTRO OPTOMETRICO DRA MONTESINOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTESINOS HUERFANOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-805-4444
Mailing Address - Street 1:CALLE DE DIEGO 53 E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-9998
Mailing Address - Country:US
Mailing Address - Phone:787-805-4444
Mailing Address - Fax:
Practice Address - Street 1:CALLE DE DIEGO E
Practice Address - Street 2:53
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4866
Practice Address - Country:US
Practice Address - Phone:787-805-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty