Provider Demographics
NPI:1841492857
Name:VAZQUEZ SANCHEZ, HERIBERTO (OD)
Entity type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:
Last Name:VAZQUEZ SANCHEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 ST. BLQ. 85-5
Mailing Address - Street 2:SIERRA BAYAMON
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-293-0915
Mailing Address - Fax:
Practice Address - Street 1:ECONO MEGA I EXPRESO TRUJILLO ALTO
Practice Address - Street 2:CARR 181 KM 4.2 BO LAS CUEVAS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-293-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR463-0092152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6-2002Medicare ID - Type Unspecified