Provider Demographics
NPI:1710913538
Name:CRUZ-MARTINEZ, WILFREDO (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:CRUZ-MARTINEZ
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE AQUAMARINA
Mailing Address - Street 2:#10 VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-258-5394
Mailing Address - Fax:787-258-8225
Practice Address - Street 1:CALLE AQUAMARINA
Practice Address - Street 2:#10 VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1944
Practice Address - Country:US
Practice Address - Phone:787-258-5394
Practice Address - Fax:787-258-8225
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREI726AMedicare UPIN