Provider Demographics
NPI:1235523374
Name:GUAYACAN VISUAL CARE MANAGEMENT INC
Entity Type:Organization
Organization Name:GUAYACAN VISUAL CARE MANAGEMENT INC
Other - Org Name:COBIAN VISUAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:H
Authorized Official - Last Name:COBIAN AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-735-5744
Mailing Address - Street 1:204 CALLE JULIO CINTRON
Mailing Address - Street 2:EDIF GUAYACAN SUITE 110
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-9989
Mailing Address - Country:US
Mailing Address - Phone:787-735-5744
Mailing Address - Fax:787-735-5744
Practice Address - Street 1:204 CALLE JULIO CINTRON
Practice Address - Street 2:EDIF GUAYACAN SUITE 110
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3311
Practice Address - Country:US
Practice Address - Phone:787-735-5744
Practice Address - Fax:787-735-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR499302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREY063AMedicare Oscar/Certification