Provider Demographics
NPI:1942237524
Name:ANTUNEZ-GAUD, SYLV IA IRIS (OD)
Entity Type:Individual
Prefix:
First Name:SYLV IA
Middle Name:IRIS
Last Name:ANTUNEZ-GAUD
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 1:954 AVE PONCE DE LEON
Mailing Address - Street 2:MIRAMAR PLAZA 9G
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3646
Mailing Address - Country:US
Mailing Address - Phone:787-721-6656
Mailing Address - Fax:787-721-6656
Practice Address - Street 1:34 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2418
Practice Address - Country:US
Practice Address - Phone:787-870-2960
Practice Address - Fax:787-870-7257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR54727Medicare ID - Type Unspecified