MEDICARE: YOLANDA NIEVES O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	655	PR
2	152W00000X	Optometrist	007242	NY

General Provider Information

NPI Number	:	1053580142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA NIEVES O.D.

Provider Business Mailing Address
First Line	:	HC 2 BOX 23330
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-9280
Country	:	US
Telephone Number	:	787-709-4635
Fax Number	:

Provider Business Practice Location Address
First Line	:	OFFICE PARK 1 SUITE 206
Second Line	:	CARR. #2 KM 156.5
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-0068
Country	:	US
Telephone Number	:	787-709-4635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/16/2023

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