MEDICARE: INTER AMERICAN UNIVERSITY OF PUERTO RICO

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1265059554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTER AMERICAN UNIVERSITY OF PUERTO RICO

Provider Business Mailing Address
First Line	:	500 CARR DR JOHN W HARRIS
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00957-6257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CARR DR JOHN W HARRIS
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00957-6257
Country	:	US
Telephone Number	:	787-765-1915
Fax Number	:	787-765-9854

Authorized Official
Title or Position	:	DEAN
Name	:	ANDRES PAGAN
Credential	:	OD
Telephone Number	:	787-765-1915

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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