=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548977994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GMT EYECARE PROFESSIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2022
-----------------------------------------------------
Last Update Date | 11/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BO. CAMARONES SECT LA LOMA CARR 560 K1.5
-----------------------------------------------------
City | VILLALBA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-974-7812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8
-----------------------------------------------------
City | VILLALBA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00766-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-974-7812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF OPTOMETRY/PRESIDENT
-----------------------------------------------------
Name | DR. GABRIELA MALDONADO TORRES
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 787-974-7812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------