Healthcare Provider Details

I. General information

NPI: 1184625618
Provider Name (Legal Business Name): OPTOMETRAS PACHECO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN PATRICIO APTS AL LADO DE BED, BATH AND BEYOND
GUAYNABO PR
00968-3200
US

IV. Provider business mailing address

11 CALLE PRINCIPAL
GUAYNABO PR
00966-2028
US

V. Phone/Fax

Practice location:
  • Phone: 787-749-0909
  • Fax: 787-749-1213
Mailing address:
  • Phone: 787-783-8994
  • Fax: 787-783-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number89
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number103
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number518
License Number StatePR

VIII. Authorized Official

Name: DR. RAMON PACHECO
Title or Position: OPTOMETRIST
Credential:
Phone: 787-749-0909