Provider Demographics
NPI:1447204169
Name:MUNIZ, JOSE M (OD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:SUITE 104 LA RAMBLA PLAZA
Mailing Address - Street 2:618 AVE TITO CASTRO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0214
Mailing Address - Country:US
Mailing Address - Phone:787-812-3554
Mailing Address - Fax:787-812-3554
Practice Address - Street 1:100 E DE DIEGO AVE
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-3011
Practice Address - Fax:787-263-0850
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR416OtherOPTOMETRIST
60063Medicare ID - Type Unspecified