Provider Demographics
NPI:1386865533
Name:REYES, DAMIAN L
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:L
Last Name:REYES
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:HC 1 BOX 2524
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-9781
Mailing Address - Country:US
Mailing Address - Phone:787-506-0525
Mailing Address - Fax:787-859-5902
Practice Address - Street 1:HC 1 BOX 2524
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-506-0525
Practice Address - Fax:787-859-5902
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR795156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician