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General NPI Number Information
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NPI Number | 1215228077
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Entity Type | Organization
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Legal Business Name | NOVO-VISION OPHTHALMOLOGY CLINIC PSC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | BUILDING PLAZA DEL CARMEN, ST 159 SUITE 306
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-802-1336
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Fax | 787-802-1333
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Provider Business Mailing Address
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Address Line | PMB 102 P.O. BOX 94000
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-802-1336
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Fax | 787-802-1333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EZER CAMACHO
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Credential | M.D.
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Telephone | 787-802-1336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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