Provider Demographics
NPI:1730590316
Name:DRA ISABEL MENDEZ MARTIR OPTOMETRA PSC
Entity type:Organization
Organization Name:DRA ISABEL MENDEZ MARTIR OPTOMETRA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-261-5547
Mailing Address - Street 1:1176 CALLE HORTENSIA
Mailing Address - Street 2:URB MANSIONES DE RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7209
Mailing Address - Country:US
Mailing Address - Phone:787-261-5547
Mailing Address - Fax:787-261-4896
Practice Address - Street 1:RIO HONDO MALL LOCAL 33B
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-261-5547
Practice Address - Fax:787-261-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2102040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty