MEDICARE: OPTOMETRAS PACHECO PSC

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	89	PR
2	152W00000X	Optometrist	103	PR
3	152W00000X	Optometrist	518	PR

General Provider Information

NPI Number	:	1184625618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOMETRAS PACHECO PSC

Provider Business Mailing Address
First Line	:	11 CALLE PRINCIPAL
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2028
Country	:	US
Telephone Number	:	787-783-8994
Fax Number	:	787-783-8994

Provider Business Practice Location Address
First Line	:	SAN PATRICIO APTS
Second Line	:	AL LADO DE BED, BATH AND BEYOND
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3200
Country	:	US
Telephone Number	:	787-749-0909
Fax Number	:	787-749-1213

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. RAMON PACHECO
Credential	:
Telephone Number	:	787-749-0909

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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