Provider Demographics
NPI:1730290628
Name:MIGENES, PEDRO JAVIER (OD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JAVIER
Last Name:MIGENES
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 1:100 CALLE ABERDEEN
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4717
Mailing Address - Country:US
Mailing Address - Phone:787-638-7080
Mailing Address - Fax:787-720-7080
Practice Address - Street 1:31 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5708
Practice Address - Country:US
Practice Address - Phone:787-720-7080
Practice Address - Fax:787-720-7080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR215180Medicare UPIN
PR9512Medicare UPIN
PR100160Medicare UPIN
PR20739Medicare UPIN
PR890160Medicare UPIN
PR9690095Medicare UPIN