MEDICARE: MRS. LINES MOUX-DAVILA OD

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	265	PR

General Provider Information

NPI Number	:	1831175439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINES MOUX-DAVILA OD

Provider Business Mailing Address
First Line	:	PO BOX 729
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687-0729
Country	:	US
Telephone Number	:	787-862-3278
Fax Number	:	787-862-6264

Provider Business Practice Location Address
First Line	:	26 BUENA VISTA ST
Second Line	:	CENTRO VISUAL MOROVIS
City	:	MOROVIS
State	:	PR
Zip	:	00687-3039
Country	:	US
Telephone Number	:	787-862-3278
Fax Number	:	787-862-6264

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	04/23/2013

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