1215072327 NPI number — DR. CARLOS REOYO O.D.

Table of content: DR. CARLOS REOYO O.D. (NPI 1215072327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215072327 NPI number — DR. CARLOS REOYO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REOYO
Provider First Name:
CARLOS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1215072327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 B SAN LORENZO SHOPPING CENTER
Provider Second Line Business Mailing Address:
BETTER VISION OPTICA
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-715-3744
Provider Business Mailing Address Fax Number:
787-715-3745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 B SAN LORENZO SHOPPING CENTER
Provider Second Line Business Practice Location Address:
BETTER VISION OPTICA
Provider Business Practice Location Address City Name:
SAN LORENZO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-715-3744
Provider Business Practice Location Address Fax Number:
787-715-3745
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  457 , 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)

  • Identifier: 6606054462 . This is a "MEDICAL CARD SYSTEM MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 50666 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 62167RE . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 890250 . This is a "MEDICARE Y MUCHO MAS MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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