Provider Demographics
NPI:1669582730
Name:VALENTIN, NELLIE (LICENSED OPTICAL)
Entity type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:LICENSED OPTICAL
Other - Prefix:MISS
Other - First Name:NELLIE
Other - Middle Name:
Other - Last Name:VALENTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSED OPTICAL
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:CALLE DR. BARRERA 41
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1397
Mailing Address - Country:US
Mailing Address - Phone:787-734-3303
Mailing Address - Fax:787-734-3303
Practice Address - Street 1:CALLE DR BARRERAS # 41
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-3303
Practice Address - Fax:787-734-3303
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146152W00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR55A1OtherAMERICAN HEALTH MEDICARE
PR660672596OtherMCS
PR215988OtherPREFERRED HEALTH
PR215988OtherPREFERRED HEALTH