Healthcare Provider Details

I. General information

NPI: 1841492857
Provider Name (Legal Business Name): HERIBERTO VAZQUEZ SANCHEZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ECONO MEGA I EXPRESO TRUJILLO ALTO CARR 181 KM 4.2 BO LAS CUEVAS
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

73 ST. BLQ. 85-5 SIERRA BAYAMON
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-293-0915
  • Fax:
Mailing address:
  • Phone: 787-293-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number463-0092
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: