MEDICARE: DR. ANGEL LUIS ROMERO 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	554	PR
2	152W00000X	Optometrist	4901005041	MI

General Provider Information

NPI Number	:	1710975503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGEL LUIS ROMERO O.D.

Provider Business Mailing Address
First Line	:	COND. TORREMOLINOS TOWER
Second Line	:	APT 303
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	787-790-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	12765 HARPER VILLAGE DR
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-8357
Country	:	US
Telephone Number	:	269-979-2832
Fax Number	:

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/21/2024

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