Provider Demographics
NPI:1740525880
Name:RIVERA, ALBERT
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:RIVERA
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 1:18 CALLE MUNOZ RIVERA
Mailing Address - Street 2:CLINICA VISUAL VILLALBA
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2227
Mailing Address - Country:US
Mailing Address - Phone:787-847-1234
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE MUNOZ RIVERA
Practice Address - Street 2:CLINICA VISUAL VILLALBA
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2227
Practice Address - Country:US
Practice Address - Phone:787-847-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR906156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician