Provider Demographics
NPI:1558972372
Name:PUERTO RICO EYECARE CENTER LLC
Entity Type:Organization
Organization Name:PUERTO RICO EYECARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-598-2020
Mailing Address - Street 1:PO BOX 8981
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8981
Mailing Address - Country:US
Mailing Address - Phone:787-585-4361
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL SAN CRISTOBAL
Practice Address - Street 2:TORRE MEDICA SUITE 341
Practice Address - City:COTTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-0001
Practice Address - Country:US
Practice Address - Phone:305-598-2020
Practice Address - Fax:305-270-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty