Provider Demographics
NPI:1770709206
Name:CARLOS RIVERA/ CENTRO VISUAL JUNCOS
Entity type:Organization
Organization Name:CARLOS RIVERA/ CENTRO VISUAL JUNCOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-734-9090
Mailing Address - Street 1:23 CALLE MARTINEZ
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-3636
Mailing Address - Country:US
Mailing Address - Phone:787-734-9090
Mailing Address - Fax:787-734-8646
Practice Address - Street 1:23 CALLE MARTINEZ
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3636
Practice Address - Country:US
Practice Address - Phone:787-734-9090
Practice Address - Fax:787-734-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherMCS OPTICA