Provider Demographics
NPI:1609179753
Name:CENTRO VISUAL PENUELAS
Entity Type:Organization
Organization Name:CENTRO VISUAL PENUELAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOUCET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-439-5601
Mailing Address - Street 1:P.O. BOX 132
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0132
Mailing Address - Country:US
Mailing Address - Phone:787-836-2999
Mailing Address - Fax:787-836-2720
Practice Address - Street 1:PLAZA PENUILAS #165 CARR. 385
Practice Address - Street 2:SUITE A-40
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-2999
Practice Address - Fax:787-836-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021498Medicare PIN
596104874Medicare UPIN