Provider Demographics
NPI:1134150618
Name:FELICIANO, CELIADE LOURDES (OD)
Entity type:Individual
Prefix:DR
First Name:CELIADE LOURDES
Middle Name:
Last Name:FELICIANO
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:LOIRE 43 VILLA SERONA
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-845-5278
Mailing Address - Fax:787-558-7034
Practice Address - Street 1:PLAZA SANTA ISABEL #9
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-5278
Practice Address - Fax:787-558-7034
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
215110OtherPREFERRED
58086FEOtherSSS
077036OtherCRUZ AZUL
7570013OtherHUMANA
39335OtherPROSAM
58086FEOtherSSS