Provider Demographics
NPI:1588981997
Name:IGLESIAS, RAMON
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAMON
Other - Middle Name:
Other - Last Name:IGLESIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3354 BROADWAY # 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7401
Mailing Address - Country:US
Mailing Address - Phone:212-234-7494
Mailing Address - Fax:
Practice Address - Street 1:3354 BROADWAY # 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7401
Practice Address - Country:US
Practice Address - Phone:212-234-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist