Healthcare Provider Details

I. General information

NPI: 1679122931
Provider Name (Legal Business Name): COROZAL VISION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO COMERCIAL SHOPPING VILLAGE CARR 159 KM 13.2
COROZAL PR
00783
US

IV. Provider business mailing address

PO BOX 634
COROZAL PR
00783-0634
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax: 787-621-3762
Mailing address:
  • Phone: 787-621-3700
  • Fax: 787-621-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PEDRO NARVAEZ
Title or Position: DIRECTOR CONTRATACIONES
Credential:
Phone: 787-621-3700