Provider Demographics
NPI:1184615569
Name:FERRER TANCO, JOSE A (OD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:FERRER TANCO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2GR727 VIA 5
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3822
Mailing Address - Country:US
Mailing Address - Phone:787-708-2244
Mailing Address - Fax:787-708-2244
Practice Address - Street 1:C9 CALLE ACUARELA
Practice Address - Street 2:HIGHLAND GARDENS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3525
Practice Address - Country:US
Practice Address - Phone:787-708-2244
Practice Address - Fax:787-708-2244
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0056975Medicare ID - Type Unspecified
V03390Medicare UPIN