Provider Demographics
NPI:1477945533
Name:RETINA CENTER OF PUERTO RICO P S C
Entity Type:Organization
Organization Name:RETINA CENTER OF PUERTO RICO P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-1900
Mailing Address - Street 1:CARR 693
Mailing Address - Street 2:PMB 152
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-6706
Mailing Address - Country:US
Mailing Address - Phone:787-854-1900
Mailing Address - Fax:787-854-1918
Practice Address - Street 1:MARGINAL CARRETERA NO 2, KM 47 7
Practice Address - Street 2:TORRE MEDICA 2 SUITE 260
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1900
Practice Address - Fax:787-854-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87876207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027791Medicare PIN
PR1184667792Medicare UPIN