Healthcare Provider Details

I. General information

NPI: 1922301977
Provider Name (Legal Business Name): AUGUSTO E CARRION O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ROBLE STREET
VEGA ALTA PR
00692-0000
US

IV. Provider business mailing address

P.O. BOX 7595
SAN JUAN PR
00916-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-390-6337
  • Fax:
Mailing address:
  • Phone: 787-390-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number681
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number681
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number681
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: