Provider Demographics
NPI:1609314871
Name:OPTOMETRY WORLD PONCE
Entity Type:Organization
Organization Name:OPTOMETRY WORLD PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BONILLA DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-848-2885
Mailing Address - Street 1:2053 PONCE BY PASS
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-848-2885
Mailing Address - Fax:
Practice Address - Street 1:2053 PONCE BY PASS
Practice Address - Street 2:STE 104
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1307
Practice Address - Country:US
Practice Address - Phone:787-848-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1053303289Medicare NSC