Provider Demographics
NPI:1659689875
Name:EYE CARE OF SAN JUAN P S C
Entity Type:Organization
Organization Name:EYE CARE OF SAN JUAN P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELATORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-289-6600
Mailing Address - Street 1:PO BOX 13953
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3953
Mailing Address - Country:US
Mailing Address - Phone:787-289-6600
Mailing Address - Fax:787-289-6622
Practice Address - Street 1:357 AVE DE LA CONSTITUCION
Practice Address - Street 2:PUERTA DE TIERRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2208
Practice Address - Country:US
Practice Address - Phone:787-289-6600
Practice Address - Fax:787-289-6622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE OF SAN JUAN P S C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9085207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicare UPIN