Provider Demographics
NPI:1922302793
Name:RIVERA, ANNETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:RIVERA
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:ISABEL B 7
Mailing Address - Street 2:URB. MANSIONES REALES
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-319-1684
Mailing Address - Fax:
Practice Address - Street 1:ISABEL B 7
Practice Address - Street 2:URB. MANSIONES REALES
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-319-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR333OtherP.R. OPTOMETRY LICENCE