Provider Demographics
NPI:1528561545
Name:PRYMED MEDICAL CARE INC
Entity Type:Organization
Organization Name:PRYMED MEDICAL CARE INC
Other - Org Name:PRYMED VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-ESTELA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:787-871-0601
Mailing Address - Street 1:PO BOX 1427
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1427
Mailing Address - Country:US
Mailing Address - Phone:787-871-0601
Mailing Address - Fax:787-871-3960
Practice Address - Street 1:BO JAGUAS
Practice Address - Street 2:CARR 149 KM 13
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-871-0601
Practice Address - Fax:787-871-3960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRYMED MEDICAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty