Provider Demographics
NPI:1306989447
Name:MENDEZ, WILSON (OPTICIAN)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE COMERCIO #69
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1634
Mailing Address - Country:US
Mailing Address - Phone:787-837-9608
Mailing Address - Fax:787-837-9608
Practice Address - Street 1:CALLE COMERCIO #69
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1634
Practice Address - Country:US
Practice Address - Phone:787-837-9608
Practice Address - Fax:787-837-9608
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR090156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician