Provider Demographics
NPI:1407884265
Name:MARRERO, EILEEN (OD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
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:PO BOX 190990 HATO REY STATION
Mailing Address - Street 2:SAN JUAN PUERTO RICO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0990
Mailing Address - Country:US
Mailing Address - Phone:787-769-2477
Mailing Address - Fax:787-276-0065
Practice Address - Street 1:CARR #3 KM 12.3 AVE. 65 INFANTERIA
Practice Address - Street 2:CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-2477
Practice Address - Fax:787-276-0065
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist