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General NPI Number Information
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NPI Number | 1235523374
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Entity Type | Organization
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Legal Business Name | GUAYACAN VISUAL CARE MANAGEMENT INC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 204 CALLE JULIO CINTRON EDIF GUAYACAN SUITE 110
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City | AIBONITO
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State | PR
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Zip | 00705-3311
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Country | US
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Telephone | 787-735-5744
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Fax | 787-735-5744
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Provider Business Mailing Address
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Address Line | 204 CALLE JULIO CINTRON EDIF GUAYACAN SUITE 110
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City | AIBONITO
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State | PR
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Zip | 00705-9989
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Country | US
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Telephone | 787-735-5744
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Fax | 787-735-5744
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. GLADYS H COBIAN AYALA
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Credential | O.D.
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Telephone | 787-735-5744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 499
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License Number State | PR
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