Provider Demographics
NPI:1679851406
Name:OJOS PUERTO RICO RETINA, PSC
Entity type:Organization
Organization Name:OJOS PUERTO RICO RETINA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RETINOLOGA
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-820-8989
Mailing Address - Street 1:300 AVE LA SIERRA APT 101
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4339
Mailing Address - Country:US
Mailing Address - Phone:787-820-8989
Mailing Address - Fax:787-820-8989
Practice Address - Street 1:1890 CALLE PETUNIA
Practice Address - Street 2:SANTA MARIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6637
Practice Address - Country:US
Practice Address - Phone:787-820-8989
Practice Address - Fax:787-820-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17473OtherLICENCIA