Provider Demographics
NPI:1053429217
Name:RIVERA, ANDRES (OD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MG-20 PLAZA 40
Mailing Address - Street 2:MARINA BAHIA
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-6786
Mailing Address - Country:US
Mailing Address - Phone:787-717-7803
Mailing Address - Fax:
Practice Address - Street 1:CALLE IGUINA #3
Practice Address - Street 2:TU CENTRO DE VISION INTEGRAL
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2624
Practice Address - Country:US
Practice Address - Phone:787-820-4622
Practice Address - Fax:787-820-4622
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0062646RIMedicare ID - Type Unspecified
U94241Medicare UPIN