Provider Demographics
NPI:1346052578
Name:RIVERA DIAZ, ERIC O SR
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:O
Last Name:RIVERA DIAZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 4881-8
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-9563
Mailing Address - Country:US
Mailing Address - Phone:787-217-0562
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 4881-8
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-9563
Practice Address - Country:US
Practice Address - Phone:787-217-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1553156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician