MEDICARE: DR. JOSE G MATOS OPTHALMOLOGY

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	006083	PR

General Provider Information

NPI Number	:	1255683736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JOSE G MATOS OPTHALMOLOGY

Provider Business Mailing Address
First Line	:	HOSTOS AVE.239
Second Line	:	STE 1202
City	:	SAN JUAN
State	:	PR
Zip	:	00918-1477
Country	:	US
Telephone Number	:	787-281-0030
Fax Number	:	787-641-3392

Provider Business Practice Location Address
First Line	:	HOSTOS AVE.239
Second Line	:	STE 1202
City	:	SAN JUAN
State	:	PR
Zip	:	00918-1477
Country	:	US
Telephone Number	:	787-281-0030
Fax Number	:	787-641-3392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE GABRIEL MATOS
Credential	:	M.D.
Telephone Number	:	787-281-0030

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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