Healthcare Provider Details

I. General information

NPI: 1336263409
Provider Name (Legal Business Name): LASER EYE SURGERY MANAGEMENT OF PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 117 CARR 165 KM 1.2 # 48 CITY VIEW PLAZA BUILDING
GUAYNABO PR
00968
US

IV. Provider business mailing address

SUITE 117 CARR 165 KM 1.2 # 48 CITY VIEW PLAZA BUILDING
GUAYNABO PR
00968
US

V. Phone/Fax

Practice location:
  • Phone: 787-775-2020
  • Fax: 787-775-2010
Mailing address:
  • Phone: 787-775-2020
  • Fax: 787-775-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGIE L JIMENEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-775-2020