Provider Demographics
NPI:1639644990
Name:ANTEOJOS DI MODA
Entity Type:Organization
Organization Name:ANTEOJOS DI MODA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-662-0422
Mailing Address - Street 1:HC 1 BOX 4231
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-9708
Mailing Address - Country:US
Mailing Address - Phone:787-662-0422
Mailing Address - Fax:
Practice Address - Street 1:METRO PLAZA CAGUAS AVE. JOSE GARRIDO VILLA BLANCA PARK
Practice Address - Street 2:LOCAL L-2
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-662-0422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty