Provider Demographics
NPI:1316097363
Name:MONTALVO-QUINONES, ERNESTO T (OD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:T
Last Name:MONTALVO-QUINONES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 7D ROOSEVELT AVE
Mailing Address - Street 2:PLAZA LAS AMERICAS
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-283-3111
Mailing Address - Fax:787-753-0852
Practice Address - Street 1:524 7D ROOSEVELT AVE
Practice Address - Street 2:PLAZA LAS AMERICAS
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-283-3111
Practice Address - Fax:787-753-0852
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist