Provider Demographics
NPI:1689754350
Name:ALVARADO, JUAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:ALVARADO
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 1:1535 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2791
Mailing Address - Country:US
Mailing Address - Phone:810-629-3070
Mailing Address - Fax:810-629-6748
Practice Address - Street 1:1535 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2791
Practice Address - Country:US
Practice Address - Phone:810-629-3070
Practice Address - Fax:810-629-6748
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN35320001Medicare ID - Type Unspecified
MIU82380Medicare UPIN