Provider Demographics
NPI:1114070646
Name:CAMACHO MENDEZ, ROSA M (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:M
Last Name:CAMACHO MENDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ROSITA
Other - Middle Name:
Other - Last Name:CAMACHO MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1500 AVE COMERIO STE 70
Mailing Address - Street 2:PLAZA DEL PARQUE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3977
Mailing Address - Country:US
Mailing Address - Phone:787-785-3220
Mailing Address - Fax:787-785-3705
Practice Address - Street 1:1500 AVE COMERIO STE 70
Practice Address - Street 2:PLAZA DEL PARQUE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3977
Practice Address - Country:US
Practice Address - Phone:787-785-3220
Practice Address - Fax:787-785-3705
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist