Provider Demographics
NPI:1295086569
Name:ANDRES RIVERA PACHECO
Entity type:Organization
Organization Name:ANDRES RIVERA PACHECO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-820-4622
Mailing Address - Street 1:MG20 PLAZA 40
Mailing Address - Street 2:MARINA BAHIA
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-6786
Mailing Address - Country:US
Mailing Address - Phone:787-820-4622
Mailing Address - Fax:787-820-4622
Practice Address - Street 1:CALLE IGUINA
Practice Address - Street 2:# 3
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-820-4622
Practice Address - Fax:787-820-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0062646RIMedicare PIN
PRU94241Medicare UPIN