Provider Demographics
NPI:1093229536
Name:LARA, EDUARDO VELEZ SR (OP)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:VELEZ
Last Name:LARA
Suffix:SR
Gender:M
Credentials:OP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CALLE PERAL NORTH
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-831-6042
Mailing Address - Fax:787-831-6042
Practice Address - Street 1:29 CALLE PERAL NORTH
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0068
Practice Address - Country:US
Practice Address - Phone:787-464-7855
Practice Address - Fax:787-464-7855
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR494156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician