Provider Demographics
NPI:1588617765
Name:TORRES, EDMUNDO (OD)
Entity Type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 PASEO VLA FLORES STE 204
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2954
Mailing Address - Country:US
Mailing Address - Phone:787-646-7938
Mailing Address - Fax:787-843-7979
Practice Address - Street 1:1681 PASEO VLA FLORES STE 204
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2954
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:787-843-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058058Medicare ID - Type Unspecified