Provider Demographics
NPI:1093839540
Name:SAN JUAN OPHTHALMOLOGY GROUP CSP
Entity Type:Organization
Organization Name:SAN JUAN OPHTHALMOLOGY GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRANCESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:787-723-4670
Mailing Address - Street 1:29 WASHINGTON STREET
Mailing Address - Street 2:SUITE 707
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1503
Mailing Address - Country:US
Mailing Address - Phone:787-723-4670
Mailing Address - Fax:787-722-6533
Practice Address - Street 1:29 WASHINGTON STREET
Practice Address - Street 2:SUITE 707
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1503
Practice Address - Country:US
Practice Address - Phone:787-723-4670
Practice Address - Fax:787-722-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9406207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF05606Medicare UPIN
PR24163Medicare ID - Type Unspecified