Provider Demographics
NPI:1457432544
Name:BERDECIA, AURA A (OD)
Entity Type:Individual
Prefix:
First Name:AURA
Middle Name:A
Last Name:BERDECIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194882
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4882
Mailing Address - Country:US
Mailing Address - Phone:787-751-1757
Mailing Address - Fax:
Practice Address - Street 1:LOCAL #5 LOS COLOBOS MALL
Practice Address - Street 2:LOS COLOBOS MALL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-776-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU196327Medicare UPIN