Provider Demographics
NPI:1417459181
Name:VEGA BATISTA, SUSAN (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:VEGA BATISTA
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 7891
Mailing Address - Street 2:PMB 333
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-944-4122
Mailing Address - Fax:787-980-8008
Practice Address - Street 1:B275 CARR 693 KM 1.5
Practice Address - Street 2:DORAMAR SHOPPING CENTER
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-980-8008
Practice Address - Fax:787-980-8008
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty