=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710975503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGEL LUIS ROMERO O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12765 HARPER VILLAGE DR
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49014-8357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-979-2832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND. TORREMOLINOS TOWER APT 303
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-790-7041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 554
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901005041
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------