Provider Demographics
NPI:1881267508
Name:GARCIA, MICHAEL JAY (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:GARCIA
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:PLAZA FAJARDO CARR 3 SUITE 125
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3611
Mailing Address - Country:US
Mailing Address - Phone:787-801-5896
Mailing Address - Fax:
Practice Address - Street 1:PLAZA FAJARDO CARR 3 SUITE 125
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3611
Practice Address - Country:US
Practice Address - Phone:787-801-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty