Provider Demographics
NPI:1255390340
Name:OPTOMETRAS PICO, TORT Y GORBEA, LLC
Entity type:Organization
Organization Name:OPTOMETRAS PICO, TORT Y GORBEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORBEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-780-0677
Mailing Address - Street 1:J12A CALLE 2
Mailing Address - Street 2:EXT. VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5077
Mailing Address - Country:US
Mailing Address - Phone:787-780-0677
Mailing Address - Fax:787-740-5070
Practice Address - Street 1:J12A CALLE 2
Practice Address - Street 2:EXT. VILLA RICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5077
Practice Address - Country:US
Practice Address - Phone:787-780-0677
Practice Address - Fax:787-740-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0434950001Medicare NSC
PR005-8079Medicare PIN