Provider Demographics
NPI:1326109414
Name:CENTRO VISUAL DE COROZAL
Entity Type:Organization
Organization Name:CENTRO VISUAL DE COROZAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBINSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:787-859-5968
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1687
Mailing Address - Country:US
Mailing Address - Phone:787-859-5968
Mailing Address - Fax:787-859-5968
Practice Address - Street 1:CARR 159 KM 13.4
Practice Address - Street 2:ORTIZ MEDICAL PLAZA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-5968
Practice Address - Fax:787-859-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR218156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051918OtherLA CRUZ AZUL DE PUERTO RI
PR890040OtherMEDICARE Y MUCHO MAS