Provider Demographics
NPI:1831175439
Name:MOUX-DAVILA, LINES (OD)
Entity type:Individual
Prefix:MRS
First Name:LINES
Middle Name:
Last Name:MOUX-DAVILA
Suffix:
Gender:F
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0729
Mailing Address - Country:US
Mailing Address - Phone:787-862-3278
Mailing Address - Fax:787-862-6264
Practice Address - Street 1:26 BUENA VISTA ST
Practice Address - Street 2:CENTRO VISUAL MOROVIS
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3039
Practice Address - Country:US
Practice Address - Phone:787-862-3278
Practice Address - Fax:787-862-6264
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10886Medicare UPIN