Healthcare Provider Details

I. General information

NPI: 1972237410
Provider Name (Legal Business Name): AOA OPHTHALMIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 CALLE JESUS RAMOS
MOCA PR
00676-4576
US

IV. Provider business mailing address

PO BOX 85
MOCA PR
00676-0085
US

V. Phone/Fax

Practice location:
  • Phone: 787-463-6992
  • Fax:
Mailing address:
  • Phone: 787-463-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-463-6992