Provider Demographics
NPI:1457469959
Name:DAVILA, EDGAR (OD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CARR 861
Mailing Address - Street 2:APT 80
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9313
Mailing Address - Country:US
Mailing Address - Phone:787-474-0881
Mailing Address - Fax:787-474-0881
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:SUITE 404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-725-9055
Practice Address - Fax:787-724-4654
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR452152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2200087OtherHUMANA
PR2200087OtherHUMANA