Provider Demographics
NPI:1053901629
Name:PONCE EYE MED INSTITUTE LCC
Entity type:Organization
Organization Name:PONCE EYE MED INSTITUTE LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-382-5195
Mailing Address - Street 1:44 CALLE MAYOR
Mailing Address - Street 2:EDIFICIO ZAMORA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3761
Mailing Address - Country:US
Mailing Address - Phone:787-848-5353
Mailing Address - Fax:787-259-4462
Practice Address - Street 1:44 CALLE MAYOR
Practice Address - Street 2:EDIFICIO ZAMORA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3761
Practice Address - Country:US
Practice Address - Phone:787-848-5353
Practice Address - Fax:787-259-4462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PONCE EYE MED INSTITUTE LCC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty