Healthcare Provider Details

I. General information

NPI: 1881267508
Provider Name (Legal Business Name): MICHAEL JAY GARCIA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 11/04/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA FAJARDO CARR 3 SUITE 125
FAJARDO PR
00738-3611
US

IV. Provider business mailing address

PLAZA FAJARDO CARR 3 SUITE 125
FAJARDO PR
00738-3611
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-5896
  • Fax:
Mailing address:
  • Phone: 787-801-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000767
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: