Provider Demographics
NPI:1205496692
Name:FELICIANO GONZALEZ, ZORY MARY (OPTICO)
Entity type:Individual
Prefix:
First Name:ZORY
Middle Name:MARY
Last Name:FELICIANO GONZALEZ
Suffix:
Gender:F
Credentials:OPTICO
Other - Prefix:
Other - First Name:ZORY
Other - Middle Name:MARY
Other - Last Name:FELICIANO GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICO
Mailing Address - Street 1:PO BOX 8730
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8730
Mailing Address - Country:US
Mailing Address - Phone:939-270-1803
Mailing Address - Fax:
Practice Address - Street 1:D8 CALLE LINARES
Practice Address - Street 2:URB VALLE DE ANDALUCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:939-270-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR768156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician