Provider Demographics
NPI:1720025471
Name:PADILLA ZAPATA, LUIS EDGARDO (OD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDGARDO
Last Name:PADILLA ZAPATA
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 397
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0397
Mailing Address - Country:US
Mailing Address - Phone:787-851-4820
Mailing Address - Fax:
Practice Address - Street 1:J C PENNEY OPTICAL DEPARTMENT
Practice Address - Street 2:PLAZA CAROLINA MALL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-752-9200
Practice Address - Fax:787-257-2665
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR 110152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9880011OtherHUMANA PUERTO RICO
PR28904PAOtherTRIPLE S