Healthcare Provider Details

I. General information

NPI: 1326409665
Provider Name (Legal Business Name): SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC. ( OPTOMETRIA)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 CRUCE DAVILA KM 57.8
BARCELONETA PR
00617-3244
US

IV. Provider business mailing address

PO BOX 2045
BARCELONETA PR
00617-2045
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-4412
  • Fax: 787-846-7410
Mailing address:
  • Phone: 787-846-4412
  • Fax: 787-846-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JENNY E PADILLA
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 787-846-4412