Provider Demographics
NPI:1306197363
Name:UTUADO VISION CENTER CSP
Entity Type:Organization
Organization Name:UTUADO VISION CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-640-8517
Mailing Address - Street 1:PO BOX 143926
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3926
Mailing Address - Country:US
Mailing Address - Phone:787-814-0707
Mailing Address - Fax:787-814-0707
Practice Address - Street 1:10 AVE ESTEVES
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-3025
Practice Address - Country:US
Practice Address - Phone:787-814-0707
Practice Address - Fax:787-814-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-30
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty