Provider Demographics
NPI:1427021880
Name:CENTRO OFTALMOLOGICO DR VAZGUEZ DIAZ
Entity Type:Organization
Organization Name:CENTRO OFTALMOLOGICO DR VAZGUEZ DIAZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD BSB
Authorized Official - Phone:787-842-4188
Mailing Address - Street 1:PO BOX 9021
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9021
Mailing Address - Country:US
Mailing Address - Phone:787-842-4188
Mailing Address - Fax:787-842-4288
Practice Address - Street 1:8111 CONCORDIA ST
Practice Address - Street 2:CONCORDIA PROFESSIONAL PLAZA SUITE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-842-4188
Practice Address - Fax:787-842-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13059207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty