Healthcare Provider Details

I. General information

NPI: 1306197363
Provider Name (Legal Business Name): UTUADO VISION CENTER CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AVE ESTEVES
UTUADO PR
00641-3025
US

IV. Provider business mailing address

PO BOX 143926
ARECIBO PR
00614-3926
US

V. Phone/Fax

Practice location:
  • Phone: 787-814-0707
  • Fax: 787-814-0707
Mailing address:
  • Phone: 787-814-0707
  • Fax: 787-814-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number147
License Number StatePR

VIII. Authorized Official

Name: DR. IVAN M SAAVEDRA
Title or Position: OPTOMETRY/OWNER
Credential: O.D.
Phone: 787-640-8517