Healthcare Provider Details

I. General information

NPI: 1548723158
Provider Name (Legal Business Name): PUERTO RICO EYE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 06/13/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA BAIROA STE 245 AVE SAKURA PR#1
CAGUAS PR
00725
US

IV. Provider business mailing address

PLAZA BAIROA 1 AVE FOMENTO SUITE 1
CAGUAS PR
00725-5763
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-3030
  • Fax:
Mailing address:
  • Phone: 787-641-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS JAVIER FERNANDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-641-3030