MEDICARE: DR. FERNANDO LUIS PADILLA O.D.

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	280	PR

General Provider Information

NPI Number	:	1295737591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO LUIS PADILLA O.D.

Provider Business Mailing Address
First Line	:	134 CALLE CARACOL
Second Line	:	ALTURAS DEL MAR
City	:	CABO ROJO
State	:	PR
Zip	:	00623-3186
Country	:	US
Telephone Number	:	939-645-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB ALTURAS DEL MAR
Second Line	:	134 CARACOL
City	:	CABO ROJO
State	:	PR
Zip	:	00623-3186
Country	:	US
Telephone Number	:	939-645-2686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/05/2016

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