Provider Demographics
NPI:1225007453
Name:NIEVES, WALTER (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:NIEVES
Suffix:
Gender:M
Credentials:MD
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 1967
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1967
Mailing Address - Country:US
Mailing Address - Phone:787-830-5784
Mailing Address - Fax:787-830-2436
Practice Address - Street 1:3285 AVE MILITAR
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4091
Practice Address - Country:US
Practice Address - Phone:787-830-5784
Practice Address - Fax:787-830-2436
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12791207W00000X
PR332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH31302Medicare UPIN
PR89627Medicare PIN