Provider Demographics
NPI:1619241171
Name:SEGARRA, JUAN CARLOS (OD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:SEGARRA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VALLE ALTO LLANURA ST.
Mailing Address - Street 2:1722
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:UM
Mailing Address - Phone:787-202-0251
Mailing Address - Fax:
Practice Address - Street 1:REPTO UNIVERSITARIO
Practice Address - Street 2:1232 AVE MUNOZ RIVERA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0639
Practice Address - Country:US
Practice Address - Phone:787-841-4539
Practice Address - Fax:787-841-2659
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist