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General NPI Number Information
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NPI Number | 1639644990
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Entity Type | Organization
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Legal Business Name | ANTEOJOS DI MODA
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | METRO PLAZA CAGUAS AVE. JOSE GARRIDO VILLA BLANCA PARK LOCAL L-2
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-662-0422
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 4231
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City | NAGUABO
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State | PR
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Zip | 00718-9708
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Country | US
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Telephone | 787-662-0422
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA I. RODRIGUEZ
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Credential | OD
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Telephone | 787-662-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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