Healthcare Provider Details

I. General information

NPI: 1477634913
Provider Name (Legal Business Name): JAVIER OCASIO O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 AVE MIRAMAR
ARECIBO PR
00612-2763
US

IV. Provider business mailing address

PO BOX 142565
ARECIBO PR
00614-2565
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-9079
  • Fax: 787-881-9079
Mailing address:
  • Phone: 787-878-9079
  • Fax: 787-881-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number388
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: