Provider Demographics
NPI:1689714099
Name:MORALES, JUAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:D
Last Name:MORALES
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:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1560
Mailing Address - Country:US
Mailing Address - Phone:787-752-3200
Mailing Address - Fax:
Practice Address - Street 1:CALLE ELEANOR ROOSEVELT #118
Practice Address - Street 2:INTER AMERICAN UNIVERSITY SCHOOL OF OPTOMETRY
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-765-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR215937OtherPREFERRED HEALTH INS.