Healthcare Provider Details

I. General information

NPI: 1902396179
Provider Name (Legal Business Name): CENTRO VISUAL MATOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 AVE BETANCES
BAYAMON PR
00959-5159
US

IV. Provider business mailing address

CAPE SEA VILLAGE 3 GARDENIA 115
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-8555
  • Fax:
Mailing address:
  • Phone: 787-379-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MYLTHIA P MATOS
Title or Position: OPTHOMETRIST
Credential: OD
Phone: 787-379-9070