Provider Demographics
NPI:1215002670
Name:OFTALMOLOGOS ASOCIADOS DEL NORTE CRL
Entity Type:Organization
Organization Name:OFTALMOLOGOS ASOCIADOS DEL NORTE CRL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-5752
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0994
Mailing Address - Country:US
Mailing Address - Phone:787-854-5752
Mailing Address - Fax:787-884-6619
Practice Address - Street 1:200 CARR 2 TORRE MEDICA I PEDRO BLANCO LUGO
Practice Address - Street 2:SUITE 210
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4661
Practice Address - Country:US
Practice Address - Phone:787-854-5752
Practice Address - Fax:787-884-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084527Medicare ID - Type Unspecified