Provider Demographics
NPI:1902040876
Name:REYES, AGUEDITA REYES
Entity Type:Individual
Prefix:MRS
First Name:AGUEDITA
Middle Name:REYES
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PERFECT
Other - Middle Name:
Other - Last Name:VISION CLINIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:CALLE 64 BLOQUE75 #48 URB. SIERRA BAYAMON
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-200-4092
Mailing Address - Fax:
Practice Address - Street 1:75-48 CALLE 64
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4538
Practice Address - Country:US
Practice Address - Phone:787-200-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156F00000XEye and Vision Services ProvidersTechnician/Technologist