Healthcare Provider Details

I. General information

NPI: 1437253887
Provider Name (Legal Business Name): CARMEN J CASABLANCA VAZQUEZ OPTOMETRY DOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON SUITE 407 ASHFORD MEDICAL CENTER
SAN JUAN PR
00907-1510
US

IV. Provider business mailing address

PASEO DE LA REINA ST. #J-3 MANSIONES REALES
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-963-0700
  • Fax:
Mailing address:
  • Phone: 787-789-5429
  • Fax: 787-789-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number00204/0038
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: