Provider Demographics
NPI:1063839967
Name:SPECIALIZED EYE CARE, C.S.P.
Entity Type:Organization
Organization Name:SPECIALIZED EYE CARE, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-510-7880
Mailing Address - Street 1:PMB 325
Mailing Address - Street 2:1353 ROAD 19
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2700
Mailing Address - Country:US
Mailing Address - Phone:787-510-7880
Mailing Address - Fax:
Practice Address - Street 1:735 AVE. PONCE DE LEON
Practice Address - Street 2:TORRE MEDICA HOSPITAL AUXILIO MUTUO #503
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5029
Practice Address - Country:US
Practice Address - Phone:787-510-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13621302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH65276Medicare UPIN