Provider Demographics
NPI:1952604209
Name:JUAN, RAMON EDGARDO (OD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:EDGARDO
Last Name:JUAN
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:PO BOX 2540
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-2540
Mailing Address - Country:US
Mailing Address - Phone:787-342-5161
Mailing Address - Fax:
Practice Address - Street 1:CARR 402 KM 4.6 BO PINALES
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-203-7611
Practice Address - Fax:787-229-1040
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038327000Medicaid
PR038327002Medicaid
PR038327001Medicaid