Provider Demographics
NPI:1881602464
Name:LATIMER, RICARDO (OD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:LATIMER
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:HC-67 BOX 89
Mailing Address - Street 2:MANSIONES SIERRA TAINA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9801
Mailing Address - Country:US
Mailing Address - Phone:787-785-0437
Mailing Address - Fax:787-785-0437
Practice Address - Street 1:LAS CATALINAS MALL
Practice Address - Street 2:LOCAL # 440
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5200
Practice Address - Country:US
Practice Address - Phone:787-746-0965
Practice Address - Fax:787-746-1309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist