Healthcare Provider Details

I. General information

NPI: 1063888097
Provider Name (Legal Business Name): JMHEYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 CARR 2 SUITE 2
VEGA BAJA PR
00693
US

IV. Provider business mailing address

4246 CARR 2 KM 43.0 SUITE 2
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-369-6591
  • Fax: 787-369-0711
Mailing address:
  • Phone: 787-369-6591
  • Fax: 787-369-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number707
License Number StatePR

VIII. Authorized Official

Name: JORGE A MELENDEZ
Title or Position: OWNER
Credential: OD
Phone: 787-374-3925