Provider Demographics
NPI:1114099454
Name:RAMOS-RIVERA, WILSON (OD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:RAMOS-RIVERA
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 1554
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-895-4512
Mailing Address - Fax:787-895-4512
Practice Address - Street 1:HONORIO HERNANDEZ
Practice Address - Street 2:#102
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-4512
Practice Address - Fax:787-895-4512
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660483218OtherCRUZ AZUL
U12315Medicare UPIN
PR58075Medicare ID - Type Unspecified