Provider Demographics
NPI:1255683736
Name:DR. JOSE G MATOS OPTHALMOLOGY
Entity Type:Organization
Organization Name:DR. JOSE G MATOS OPTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-281-0030
Mailing Address - Street 1:HOSTOS AVE.239
Mailing Address - Street 2:STE 1202
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1477
Mailing Address - Country:US
Mailing Address - Phone:787-281-0030
Mailing Address - Fax:787-641-3392
Practice Address - Street 1:HOSTOS AVE.239
Practice Address - Street 2:STE 1202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1477
Practice Address - Country:US
Practice Address - Phone:787-281-0030
Practice Address - Fax:787-641-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006083207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty