Provider Demographics
NPI:1740822253
Name:BATISTA, CLEIDY JOAN (OPT)
Entity type:Individual
Prefix:
First Name:CLEIDY
Middle Name:JOAN
Last Name:BATISTA
Suffix:
Gender:F
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. LOS VETERANOS KM 134.7
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-1060
Mailing Address - Fax:787-864-1210
Practice Address - Street 1:CARR 651 KM 2.5
Practice Address - Street 2:BO HATO ARRIBA SECTOR EL JUNCO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-7396
Practice Address - Fax:787-815-4433
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1200156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician