Provider Demographics
NPI:1740335082
Name:QUINONES-COLON, VICTOR J (OD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:QUINONES-COLON
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:AVE GAUTIER BENITEZ 112
Mailing Address - Street 2:ESQUINA JOSE MERCADO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-643-2187
Mailing Address - Fax:787-743-8974
Practice Address - Street 1:AVE GAUTIER BENITEZ 112
Practice Address - Street 2:ESQUINA JOSE MERCADO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-643-2187
Practice Address - Fax:787-743-8974
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR234-0276152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-8108Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRU 41933Medicare UPIN