Provider Demographics
NPI:1376566240
Name:CARRILES, OSVALDO
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:CARRILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:OPTOMETRY WORLD
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1151
Mailing Address - Country:US
Mailing Address - Phone:787-755-7077
Mailing Address - Fax:787-283-7077
Practice Address - Street 1:ST MUNOZ RIVERA #157
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-6649
Practice Address - Fax:787-715-6649
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09445575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
58057Medicare ID - Type Unspecified