Provider Demographics
NPI:1093982688
Name:LUGO-BAEZ, ELVIN ANTONIO (OD)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:ANTONIO
Last Name:LUGO-BAEZ
Suffix:
Gender:M
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:PO BOX 9386
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9386
Mailing Address - Country:US
Mailing Address - Phone:787-653-2275
Mailing Address - Fax:
Practice Address - Street 1:200 AVE FRAGOSO STE 157
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3172
Practice Address - Country:US
Practice Address - Phone:787-750-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist