Healthcare Provider Details

I. General information

NPI: 1811980915
Provider Name (Legal Business Name): VICTOR MANUEL ROSA REYES OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 185 K15.5
CANOVANAS PR
00729
US

IV. Provider business mailing address

PO BOX 1229
JUNCOS PR
00777-1229
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-1417
  • Fax: 787-787-9576
Mailing address:
  • Phone: 787-752-1417
  • Fax: 787-787-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number432
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: