MEDICARE: WENCESLAO REYES

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	156FX1800X	Optician	399	PR

General Provider Information

NPI Number	:	1386749687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENCESLAO REYES

Provider Business Mailing Address
First Line	:	#1753 CALLE PAFOS
Second Line	:	URB VENUS GRDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-605-7317
Fax Number	:

Provider Business Practice Location Address
First Line	:	#1753 CALLE PAFOS
Second Line	:	URB VENUS GRDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-605-7317
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/16/2015

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