Healthcare Provider Details

I. General information

NPI: 1528224938
Provider Name (Legal Business Name): VISION 4 YOU CLINICA VISUAL DRA. FELICIANO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CARR. 153 STE 7 LOCAL PLAZA BO. PASO SECO
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

CALLE LOIRE # 43 VILLA SERENA
SANTA ISABEL PR
00757
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-5278
  • Fax: 787-558-7034
Mailing address:
  • Phone: 787-845-5278
  • Fax: 787-558-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number295003
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number295-003
License Number StatePR

VIII. Authorized Official

Name: MR. HELBERT ROMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-402-1906