Provider Demographics
NPI:1336263409
Name:LASER EYE SURGERY MANAGEMENT OF PR
Entity Type:Organization
Organization Name:LASER EYE SURGERY MANAGEMENT OF PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-775-2020
Mailing Address - Street 1:SUITE 117 CARR 165 KM 1.2 # 48
Mailing Address - Street 2:CITY VIEW PLAZA BUILDING
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-775-2020
Mailing Address - Fax:787-775-2010
Practice Address - Street 1:SUITE 117 CARR 165 KM 1.2 # 48
Practice Address - Street 2:CITY VIEW PLAZA BUILDING
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-775-2020
Practice Address - Fax:787-775-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery