Provider Demographics
NPI:1558629089
Name:WESTERN VISUAL CARE PSC
Entity Type:Organization
Organization Name:WESTERN VISUAL CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:JUAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-342-5161
Mailing Address - Street 1:PO BOX 2540
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-2540
Mailing Address - Country:US
Mailing Address - Phone:787-203-7611
Mailing Address - Fax:
Practice Address - Street 1:CARR 402 KM 4.6 BO PINALES
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-203-7611
Practice Address - Fax:787-229-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR682-251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038327000Medicaid
PR038637101Medicaid
PR038637100Medicaid
PR038637102Medicaid
PR038327001Medicaid
PR038327002Medicaid