Provider Demographics
NPI:1851895874
Name:CENTRO OPTOMETRICO ESPECIALIZADO DE PR LLC
Entity Type:Organization
Organization Name:CENTRO OPTOMETRICO ESPECIALIZADO DE PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD, F I A O
Authorized Official - Phone:787-200-5527
Mailing Address - Street 1:BAYAMON MEDICAL BUILDING
Mailing Address - Street 2:J23 AVE BETANCES URB HERMANAS DAVILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-200-5527
Mailing Address - Fax:787-779-3900
Practice Address - Street 1:ESTANCIAS DE RIO HONDO III
Practice Address - Street 2:CC36 CALLE CEIBAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3419
Practice Address - Country:US
Practice Address - Phone:787-798-3333
Practice Address - Fax:787-779-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty