Provider Demographics
NPI:1518268051
Name:CANOVANAS EYE GROUP
Entity Type:Organization
Organization Name:CANOVANAS EYE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALSINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-585-6620
Mailing Address - Street 1:181 PMB LA CUMBRE
Mailing Address - Street 2:273 SIERRA MORENA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0000
Mailing Address - Country:US
Mailing Address - Phone:787-585-6620
Mailing Address - Fax:787-655-4375
Practice Address - Street 1:5802 WMSC PLAZA CONOVANAS
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-957-2711
Practice Address - Fax:787-523-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty