=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508064478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANCISCO J CORDERO-VARGAS OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 CALLE LUIS MUNOZ RIVERA
-----------------------------------------------------
City | GUAYANILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00656-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-835-3623
-----------------------------------------------------
Fax | 787-840-3341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 CALLE LUIS MUNOZ RIVERA
-----------------------------------------------------
City | GUAYANILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00656-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-835-3623
-----------------------------------------------------
Fax | 787-840-3341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 00276-101
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------