Provider Demographics
NPI:1558579458
Name:FELICIANO, NILDA I (OD)
Entity Type:Individual
Prefix:DR
First Name:NILDA
Middle Name:
Last Name:FELICIANO
Suffix:I
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 CALLE IGUALDAD
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2308
Mailing Address - Country:US
Mailing Address - Phone:787-486-2127
Mailing Address - Fax:
Practice Address - Street 1:IGUALDAD ST. #2259 URB.CONSTANCIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2309
Practice Address - Country:US
Practice Address - Phone:787-486-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist