Provider Demographics
NPI:1962505404
Name:VALLES, JOSE D (OD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:D
Last Name:VALLES
Suffix:
Gender:M
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:PLAZA DEL SOL MALL STE 1010
Mailing Address - Street 2:725 WEST MAIN AVE.
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-740-1325
Mailing Address - Fax:787-740-1325
Practice Address - Street 1:ACTIVE EYES, PLAZA DEL SOL MALL, 725 W. MAIN AVE
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-1325
Practice Address - Fax:787-740-1325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist