Provider Demographics
NPI:1992822720
Name:OLIVERAS, IVELISSE (OD)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:OLIVERAS
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:PO BOX 3431
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3431
Mailing Address - Country:US
Mailing Address - Phone:939-940-1876
Mailing Address - Fax:
Practice Address - Street 1:1500 AVE COMERIO STE 1
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3976
Practice Address - Country:US
Practice Address - Phone:787-622-9462
Practice Address - Fax:787-787-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist