Provider Demographics
NPI:1679793905
Name:MORA-ANTONGIORGI, LUIS E (OD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:MORA-ANTONGIORGI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:576 AVE ARTERIAL B APT 2309
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-892-1218
Mailing Address - Fax:787-892-7480
Practice Address - Street 1:525 AVE ROOSEVELT
Practice Address - Street 2:PLAZA LAS AMERICAS LENSCRAFTERS 0474
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-6431
Practice Address - Fax:787-753-0852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR403-0029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038172400Medicaid