MEDICARE: DR. OSVALDO ANTONIO NEGRON 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	152WP0200X	Pediatric Optometrist	417	PR
2	152WP0200X	Pediatric Optometrist	DA2217	MD
3	152WP0200X	Pediatric Optometrist	4901004515	MI

General Provider Information

NPI Number	:	1770575946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSVALDO ANTONIO NEGRON O.D.

Provider Business Mailing Address
First Line	:	PO BOX 2069
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-2069
Country	:	US
Telephone Number	:	787-590-9014
Fax Number	:

Provider Business Practice Location Address
First Line	:	30002 VALLE DEL AMANECER
Second Line	:	VALLE DORADO
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:	787-855-1414
Fax Number	:

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/19/2013

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