Provider Demographics
NPI:1467665190
Name:GENERAL OPHTHALMOLOGY GROUP CSP
Entity Type:Organization
Organization Name:GENERAL OPHTHALMOLOGY GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAYDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-2991
Mailing Address - Street 1:1095 CALLE WILSON
Mailing Address - Street 2:APT 1601
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1799
Mailing Address - Country:US
Mailing Address - Phone:787-725-2991
Mailing Address - Fax:787-725-2991
Practice Address - Street 1:65TH INFANTERY AVENUE KM.12.3
Practice Address - Street 2:INSTITUTO DE OJOS Y PIEL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-2477
Practice Address - Fax:787-276-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11807207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty