Provider Demographics
NPI:1528022027
Name:CENTRO OFTALMOLOGICO METROPOLITANO CSP
Entity Type:Organization
Organization Name:CENTRO OFTALMOLOGICO METROPOLITANO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-781-2565
Mailing Address - Street 1:PO BOX 10431
Mailing Address - Street 2:CENTRO OFTALMOLOGICO METROPOLITANO CSP
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0431
Mailing Address - Country:US
Mailing Address - Phone:787-781-2565
Mailing Address - Fax:787-782-9524
Practice Address - Street 1:AVE JESUS T PINERO #1250 CAPARRA TERRACE
Practice Address - Street 2:CENTRO OFTALMOLOGICO METROPOLITANO CSP
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-781-2565
Practice Address - Fax:787-782-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSSN