Provider Demographics
NPI:1679629422
Name:VAZQUEZ, REINALDO M (OD)
Entity Type:Individual
Prefix:
First Name:REINALDO
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CALLE CORAL
Mailing Address - Street 2:REPTO PUEBLO NUEVO
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4306
Mailing Address - Country:US
Mailing Address - Phone:787-264-4431
Mailing Address - Fax:787-833-9200
Practice Address - Street 1:53 CALLE CORAL
Practice Address - Street 2:REPTO PUEBLO NUEVO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4306
Practice Address - Country:US
Practice Address - Phone:787-264-4431
Practice Address - Fax:787-833-9200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist