Provider Demographics
NPI:1083642193
Name:ACEVEDO, IVONNE V (OD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:V
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT ROOSEVELT #521 CALLE RAFAEL LAMAR
Mailing Address - Street 2:SAN JUAN PUERTO RICO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2654
Mailing Address - Country:US
Mailing Address - Phone:787-314-9740
Mailing Address - Fax:
Practice Address - Street 1:EXT ROOSEVELT #521 CALLE RAFAEL LAMAR
Practice Address - Street 2:SAN JUAN PUERTO RICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2654
Practice Address - Country:US
Practice Address - Phone:787-314-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist