Provider Demographics
NPI:1881739985
Name:VAZQUEZ, NILDA (OD)
Entity type:Individual
Prefix:DR
First Name:NILDA
Middle Name:
Last Name:VAZQUEZ
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 1:12 B SAN LORENZO SHOPPING CENTER
Mailing Address - Street 2:BETTER VISION OPTICA
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-715-3744
Mailing Address - Fax:787-715-3745
Practice Address - Street 1:12 B SAN LORENZO SHOPPING CENTER
Practice Address - Street 2:BETTER VISION OPTICA
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-715-3744
Practice Address - Fax:787-715-3745
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50666AOtherPMC MEDICARE CHOICE
PR62168VAOtherTRIPLE S
PR6606054461OtherMEDICAL CARD SYSTEM MCS
PR890251OtherMEDICARE Y MUCHO MAS MMM
RI5212OtherAMERICAN HELATH MEDICARE
PR6606054461OtherMEDICAL CARD SYSTEM MCS
PRIM204ZMedicare PIN
PR62168VAOtherTRIPLE S