Provider Demographics
NPI:1790945772
Name:PEREZ GONZALEZ, JOSE ELI (OD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ELI
Last Name:PEREZ GONZALEZ
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:BOX 129
Mailing Address - Street 2:CONDOMINIO ALTOMONTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0001
Mailing Address - Country:US
Mailing Address - Phone:787-738-7120
Mailing Address - Fax:787-738-7140
Practice Address - Street 1:4005 PEREZ HERMANOS PLAZA
Practice Address - Street 2:JESUS T PINEIRO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-7120
Practice Address - Fax:787-738-7140
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist