Provider Demographics
NPI:1427131929
Name:ERAUSQUIN COLON, MIRLA K (OD)
Entity type:Individual
Prefix:
First Name:MIRLA
Middle Name:K
Last Name:ERAUSQUIN COLON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MIRLA
Other - Middle Name:K
Other - Last Name:ERAUSQUIN COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:CONDOMINIO BALCONES DE MONTE REAL APT 6601
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-396-6623
Mailing Address - Fax:
Practice Address - Street 1:PLAZA CAROLINA MALL LOCAL 245 SECOND FLOOR
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-701-3165
Practice Address - Fax:787-701-3168
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR204339Medicare UPIN