Healthcare Provider Details

I. General information

NPI: 1639966393
Provider Name (Legal Business Name): SPECIALIZED EYE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CALLE MENDEZ VIGO
DORADO PR
00646-4800
US

IV. Provider business mailing address

PO BOX 317
DORADO PR
00646-0317
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-4155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO J DAVILA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-604-5429