Provider Demographics
NPI:1225605181
Name:CENTRO OPTICO CAYEY CORP.
Entity Type:Organization
Organization Name:CENTRO OPTICO CAYEY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-738-7120
Mailing Address - Street 1:PO BOX 372000
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2000
Mailing Address - Country:US
Mailing Address - Phone:787-738-7120
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA JESUS T. PINEIRO 4005
Practice Address - Street 2:PEREZ HNOS. PLAZA
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-7120
Practice Address - Fax:787-738-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6179310001Medicaid