Provider Demographics
NPI:1780704916
Name:GURREA, MERCEDES T (OD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:T
Last Name:GURREA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:246 CALLE MANATI
Mailing Address - Street 2:COCO BEACH
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-4615
Mailing Address - Country:US
Mailing Address - Phone:787-366-0827
Mailing Address - Fax:787-888-5162
Practice Address - Street 1:ROAD # 3 ,KM 43.3 CORNER 194
Practice Address - Street 2:PLAZA FAJARDO SHOPPING CENTER
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR152W00000XMedicare UPIN