Provider Demographics
NPI:1902043466
Name:IRIZARRY, JANNIECEL MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANNIECEL
Middle Name:MARIE
Last Name:IRIZARRY
Suffix:
Gender:F
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:COND ACQUALINA
Mailing Address - Street 2:186 CARR 2 APT 404
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-612-8118
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE DE DIEGO #51
Practice Address - Street 2:CIALES VISUAL
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-871-3091
Practice Address - Fax:787-871-3091
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist