Provider Demographics
NPI:1902396179
Name:CENTRO VISUAL MATOS
Entity Type:Organization
Organization Name:CENTRO VISUAL MATOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLTHIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-379-9070
Mailing Address - Street 1:CAPE SEA VILLAGE
Mailing Address - Street 2:3 GARDENIA 115
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-379-9070
Mailing Address - Fax:
Practice Address - Street 1:191 AVE BETANCES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5159
Practice Address - Country:US
Practice Address - Phone:787-787-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty