Provider Demographics
NPI:1457780199
Name:PEREZ, RENE
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 AVE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4779
Mailing Address - Country:US
Mailing Address - Phone:787-880-1911
Mailing Address - Fax:
Practice Address - Street 1:153 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4779
Practice Address - Country:US
Practice Address - Phone:787-880-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660348061OtherEYE CARE