MEDICARE: MRS. ROSALINE VAZQUEZ LICENCES OPTICIAN

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	529	PR

General Provider Information

NPI Number	:	1801173711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSALINE VAZQUEZ LICENCES OPTICIAN

Provider Business Mailing Address
First Line	:	65 CALLE BALDORIOTY
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2344
Country	:	US
Telephone Number	:	787-428-5503
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 CALLE BALDORIOTY
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2344
Country	:	US
Telephone Number	:	787-428-5503
Fax Number	:

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

Provider Enumeration Date	:	11/05/2011
Last Update Date	:	11/05/2011

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