MEDICARE: EYE MD ASSOCIATES, CSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1023159126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE MD ASSOCIATES, CSP

Provider Business Mailing Address
First Line	:	PO BOX 7891
Second Line	:	PMB 125
City	:	GUAYNABO
State	:	PR
Zip	:	00970-7891
Country	:	US
Telephone Number	:	787-785-6410
Fax Number	:	787-785-6468

Provider Business Practice Location Address
First Line	:	73 CALLE SANTA CRUZ STE 312
Second Line	:	EDIFICIO MEDICO SANTA CRUZ
City	:	BAYAMON
State	:	PR
Zip	:	00961-6919
Country	:	US
Telephone Number	:	787-785-6410
Fax Number	:	787-785-6468

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS HERNANDEZ RIOS
Credential	:	MD
Telephone Number	:	787-785-6410

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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