Provider Demographics
NPI:1659805901
Name:CENTRO OPTOMETRICO DRA MONTESINOS
Entity Type:Organization
Organization Name:CENTRO OPTOMETRICO DRA MONTESINOS
Other - Org Name:CENTRO OPTOMETRICO DRA MONTESINOS CENTRO OPTOMETRICO
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:MONTESESINOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-805-4444
Mailing Address - Street 1:53 CALLE DE DIEGO ESTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-805-4444
Mailing Address - Fax:
Practice Address - Street 1:53 CALLE DE DIEGO ESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty