Provider Demographics
NPI:1255479333
Name:OJEDA ANNEXY, ROSA M (OD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:OJEDA ANNEXY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9068
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VISION WORLD AVE. FRAGOSO
Practice Address - Street 2:PLAZA CAROLINA MALL LOCAL #275
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-276-1969
Practice Address - Fax:787-276-1969
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR51157OtherPMC
PR1255479333OtherMEDICARE OPTIMO
PR1255479333OtherTRIPLE-S
PR890960OtherMMM