Provider Demographics
NPI:1962626705
Name:ETTIENNE LUGO DELGADO
Entity Type:Organization
Organization Name:ETTIENNE LUGO DELGADO
Other - Org Name:DBA ACCU VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ETTIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-262-1486
Mailing Address - Street 1:4 CALLE HOLLYWOOD DR
Mailing Address - Street 2:URB. HOLLYWOOD ESTATES BO. QUEBRADA ARENAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-262-1486
Mailing Address - Fax:787-262-1486
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 5
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0000
Practice Address - Country:US
Practice Address - Phone:787-262-1486
Practice Address - Fax:787-262-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR573152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty