Healthcare Provider Details

I. General information

NPI: 1689865545
Provider Name (Legal Business Name): DORIS MARGARITA ANTUNEZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MG56 PLAZA 31 MARINA BAHIA
CATANO PR
00962-6778
US

IV. Provider business mailing address

MG56 PLAZA 31 MARINA BAHIA
CATANO PR
00962-6778
US

V. Phone/Fax

Practice location:
  • Phone: 787-390-2490
  • Fax: 787-788-3798
Mailing address:
  • Phone: 787-390-2490
  • Fax: 787-788-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number126
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: