Provider Demographics
NPI:1013090315
Name:PADILLA-TORRES, CARLOS (OD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PADILLA-TORRES
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 1:372 CALLE GORRION
Mailing Address - Street 2:CAMINO DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2815
Mailing Address - Country:US
Mailing Address - Phone:787-840-0909
Mailing Address - Fax:787-841-6607
Practice Address - Street 1:134 KILOMETRO 77.6
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-0310
Practice Address - Fax:787-850-0411
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRT26857Medicare UPIN
PR54733-PAMedicare ID - Type Unspecified