Provider Demographics
NPI:1336294503
Name:SANTIAGO COLON, ANGEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:L
Last Name:SANTIAGO COLON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CARR 149 SUITE 255
Mailing Address - Street 2:MANATI SHOPPING CENTER
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-6222
Mailing Address - Fax:787-854-6660
Practice Address - Street 1:10 CARR 149 SUITE 255
Practice Address - Street 2:MANATI SHOPPING CENTER
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-6222
Practice Address - Fax:787-854-6660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR434OtherLA JUNTA EXAMINADORA DE O