Provider Demographics
NPI:1700079555
Name:JOSHARA PEVEZ MOREUO
Entity Type:Organization
Organization Name:JOSHARA PEVEZ MOREUO
Other - Org Name:OPTIKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-851-9285
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-851-9285
Mailing Address - Fax:787-851-9285
Practice Address - Street 1:#38 MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-9285
Practice Address - Fax:787-851-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR521126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR53440Medicare PIN
PRU82882Medicare UPIN