Provider Demographics
NPI:1396717716
Name:LUGO, JOSE N (OD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:N
Last Name:LUGO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:10000 AVE 65 INFANTERIA STE 112
Mailing Address - Street 2:CAROLINA SHOPPING COURT
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5638
Mailing Address - Country:US
Mailing Address - Phone:787-750-6705
Mailing Address - Fax:787-762-3212
Practice Address - Street 1:10000 AVE 65 INFANTERIA STE 112
Practice Address - Street 2:CAROLINA SHOPPING COURT
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5638
Practice Address - Country:US
Practice Address - Phone:787-750-6705
Practice Address - Fax:787-762-3212
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-8095Medicare ID - Type Unspecified