1144405614 NPI number — PEREZ TOSSAS OPTOMETRIST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144405614 NPI number — PEREZ TOSSAS OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEREZ TOSSAS OPTOMETRIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144405614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 JUAN C. BORBON
Provider Second Line Business Mailing Address:
PMB 147 SUITE 67
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-5375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-287-0353
Provider Business Mailing Address Fax Number:
787-287-0353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 CALLE JUAN C BORBON
Provider Second Line Business Practice Location Address:
PMB 147 SUITE 67
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-5374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-287-0353
Provider Business Practice Location Address Fax Number:
787-287-0353
Provider Enumeration Date:
01/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
787-287-0353

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  300 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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