Healthcare Provider Details

I. General information

NPI: 1760437248
Provider Name (Legal Business Name): EYE SURGERY SPECIALISTS OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 HIPODROMO STREET
SANTURCE PR
00909
US

IV. Provider business mailing address

BOX 8407
SAN JUAN PR
00910-8407
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-8330
  • Fax: 787-722-3222
Mailing address:
  • Phone: 787-721-8330
  • Fax: 787-722-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIA TIRADO
Title or Position: EXECUTIVE DIRECTOR
Credential: M.H.S.A.
Phone: 787-721-8330