Healthcare Provider Details

I. General information

NPI: 1497805451
Provider Name (Legal Business Name): GRACE M WILEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.172 DE CAGUAS A CIDRA ; URB. TURABO GARDENS PRIMER PISO, HOSPTAL MENONITA CAGUAS
CAGUAS PR
00725-0000
US

IV. Provider business mailing address

423 CALLE SAN JULIAN URB SAGRADO CORAZON
SAN JUAN PR
00926-4243
US

V. Phone/Fax

Practice location:
  • Phone: 787-637-0834
  • Fax:
Mailing address:
  • Phone: 787-637-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number464
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: