Provider Demographics
NPI:1114999745
Name:MATOS, MARGARET L (OD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:MATOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 AVE SAN CLAUDIO
Mailing Address - Street 2:SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4107
Mailing Address - Country:US
Mailing Address - Phone:787-760-0950
Mailing Address - Fax:787-748-9207
Practice Address - Street 1:404 AVE SAN CLAUDIO
Practice Address - Street 2:SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4107
Practice Address - Country:US
Practice Address - Phone:787-760-0950
Practice Address - Fax:787-748-9207
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU39399Medicare UPIN