Provider Demographics
NPI:1063758472
Name:STAR EYES CORP.
Entity type:Organization
Organization Name:STAR EYES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-463-1845
Mailing Address - Street 1:CALLE 10 S.O. # 1528 CAPARRA TERRAC
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-941-8089
Mailing Address - Fax:
Practice Address - Street 1:10 S.O ST.
Practice Address - Street 2:# 1528 CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-463-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2075628302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization