Provider Demographics
NPI:1730140674
Name:GORBEA LANDRON, PEDRO J (OD OPTOMETRISTS)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:GORBEA LANDRON
Suffix:
Gender:M
Credentials:OD OPTOMETRISTS
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:J
Other - Last Name:GORBEA LANDRON
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:OD OPTOMETRIST
Mailing Address - Street 1:PO BOX 10431
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0431
Mailing Address - Country:US
Mailing Address - Phone:787-781-2565
Mailing Address - Fax:787-782-9524
Practice Address - Street 1:AVE JESUS T PINERO #1250 CAPARRA TERRACE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-2565
Practice Address - Fax:787-782-9524
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0024161NMedicare PIN
PRU31036Medicare UPIN