Provider Demographics
NPI:1417455312
Name:ACEVEDO, ARIETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:ARIETTE
Middle Name:
Last Name:ACEVEDO
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 9386
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9386
Mailing Address - Country:US
Mailing Address - Phone:787-653-2275
Mailing Address - Fax:
Practice Address - Street 1:9410 AVE LOS ROMEROS STE 35A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7003
Practice Address - Country:US
Practice Address - Phone:787-789-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist