Provider Demographics
NPI:1629268362
Name:GUERRA CUEVAS, LYDIA (OD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:GUERRA CUEVAS
Suffix:
Gender:F
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:CALLE JOSE BARBOSA #160
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-3615
Mailing Address - Fax:787-877-3615
Practice Address - Street 1:CALLE JOSE BARBOSA #160
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-3615
Practice Address - Fax:787-877-3615
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR329152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58153-GUMedicare PIN