Provider Demographics
NPI:1528224938
Name:VISION 4 YOU CLINICA VISUAL DRA. FELICIANO CSP
Entity Type:Organization
Organization Name:VISION 4 YOU CLINICA VISUAL DRA. FELICIANO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HELBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-402-1906
Mailing Address - Street 1:CALLE LOIRE # 43 VILLA SERENA
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-845-5278
Mailing Address - Fax:787-558-7034
Practice Address - Street 1:809 CARR. 153 STE 7 LOCAL PLAZA
Practice Address - Street 2:BO. PASO SECO
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-5278
Practice Address - Fax:787-558-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR295003152W00000X
PR295-003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR295-003OtherLICENSE
PR58086OtherTRIPLE-S
PR0058086Medicare PIN
PRF72385Medicare UPIN