Provider Demographics
NPI:1588709661
Name:R & V VISION SERVICES PSC
Entity type:Organization
Organization Name:R & V VISION SERVICES PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-715-3744
Mailing Address - Street 1:SAN LORENZO SHOPPING CTR
Mailing Address - Street 2:SUITE 12 B CARR 183 KM 1 1
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-4534
Mailing Address - Country:US
Mailing Address - Phone:787-715-3744
Mailing Address - Fax:787-715-3745
Practice Address - Street 1:SAN LORENZO SHOPPING CTR
Practice Address - Street 2:SUITE 12 B CARR 183 KM 1 1
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4534
Practice Address - Country:US
Practice Address - Phone:787-715-3744
Practice Address - Fax:787-715-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR457152W00000X
PR462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07540051OtherHUMANA HEALTH PLANS
PR0077162OtherLA CRUZ AZUL
PR04140OtherAMERICAN HEALTH
PR215131OtherPREFERRED HEALTH
PR34255OtherPROSSAM
PR04140OtherAMERICAN HEALTH
PR34255OtherPROSSAM
PR=========OtherMEDICARE Y MUCHO MAS MMM
PR07540051OtherHUMANA HEALTH PLANS
PR=========OtherFIRST MEDICAL IMC
PR062225Medicare ID - Type UnspecifiedMEDICARE PART B