Provider Demographics
NPI:1598003097
Name:MARIN, ELIOT
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:
Last Name:MARIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CRISTRINA
Mailing Address - Street 2:NUM. 75
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3753
Mailing Address - Country:US
Mailing Address - Phone:787-843-9967
Mailing Address - Fax:
Practice Address - Street 1:CALLE CRISTRINA
Practice Address - Street 2:NUM. 75
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3753
Practice Address - Country:US
Practice Address - Phone:787-843-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR853156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician