Healthcare Provider Details

I. General information

NPI: 1770709206
Provider Name (Legal Business Name): CARLOS RIVERA/ CENTRO VISUAL JUNCOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CALLE MARTINEZ
JUNCOS PR
00777-3636
US

IV. Provider business mailing address

23 CALLE MARTINEZ
JUNCOS PR
00777-3636
US

V. Phone/Fax

Practice location:
  • Phone: 787-734-9090
  • Fax: 787-734-8646
Mailing address:
  • Phone: 787-734-9090
  • Fax: 787-734-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS A RIVERA ALONSO
Title or Position: OPTOMETRIST
Credential: OD
Phone: 787-734-9090