Provider Demographics
NPI:1467412890
Name:MORELL AGRINSONI, MANUEL J (OD)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:J
Last Name:MORELL AGRINSONI
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 1:12 ESTE CALLE DE DIEGO
Mailing Address - Street 2:EDIFICIO FRONTERA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4885
Mailing Address - Country:US
Mailing Address - Phone:787-805-1040
Mailing Address - Fax:787-805-1040
Practice Address - Street 1:EDIF FRONTERA E
Practice Address - Street 2:CALLE DE DIEGO #12E
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4885
Practice Address - Country:US
Practice Address - Phone:787-805-1040
Practice Address - Fax:787-805-1040
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58222Medicare ID - Type Unspecified
PRU73277Medicare UPIN