Provider Demographics
NPI:1053551929
Name:CLINICA DE OJOS DE GUAYAMA INC
Entity type:Organization
Organization Name:CLINICA DE OJOS DE GUAYAMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIEST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-864-7902
Mailing Address - Street 1:COMMERCE PLAZA URB. COSTA AZUL
Mailing Address - Street 2:SUITE 101 G CALLE 13 ESQ CALLE 11
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-7902
Mailing Address - Fax:787-864-7902
Practice Address - Street 1:COMMERCE PLAZA URB. COSTA AZUL
Practice Address - Street 2:SUITE 101 G CALLE 13 ESQ CALLE 11
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-7902
Practice Address - Fax:787-864-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR471261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health