Provider Demographics
NPI:1558517052
Name:COLLAZO, PEDRO MANUEL
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:MANUEL
Last Name:COLLAZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:METRO
Other - Middle Name:OPTICAL
Other - Last Name:GROUP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:METRO OFFICE PARK
Mailing Address - Street 2:BUIDING #3 SUITE 107
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-383-5577
Mailing Address - Fax:
Practice Address - Street 1:METRO OFFICE PARK
Practice Address - Street 2:BUIDING #3 SUITE 107
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-383-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician