Provider Demographics
NPI:1700297165
Name:MORENO ARIAS, HECTOR (OD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:MORENO ARIAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:APTO 1005 COND VISTAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3152
Mailing Address - Country:US
Mailing Address - Phone:201-381-8014
Mailing Address - Fax:
Practice Address - Street 1:600 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:APTO 1005 COND VISTAS DE SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3152
Practice Address - Country:US
Practice Address - Phone:201-381-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1025OtherOPTOMETRY