MEDICARE: DR. DENIS M LIVINGSTONE 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	152WL0500X	Low Vision Rehabilitation Optometrist	111	PR

General Provider Information

NPI Number	:	1326026295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENIS M LIVINGSTONE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 191341
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1341
Country	:	US
Telephone Number	:	787-645-4949
Fax Number	:	787-727-4949

Provider Business Practice Location Address
First Line	:	200 AVE RAFAEL CORDERO
Second Line	:	SUITE 111, JCPENNEY OPTICAL
City	:	CAGUAS
State	:	PR
Zip	:	00725-3740
Country	:	US
Telephone Number	:	787-645-4949
Fax Number	:	787-727-4949

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

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	07/08/2007

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