Provider Demographics
NPI:1962696500
Name:CLINICA OPTOMETRICA DR. MANUEL MORELL-AGRINSONI, CSP
Entity type:Organization
Organization Name:CLINICA OPTOMETRICA DR. MANUEL MORELL-AGRINSONI, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-805-1040
Mailing Address - Street 1:CALLE DE DIEGO 12 ESTE
Mailing Address - Street 2:EDIFICIO FRONTERA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-805-1040
Mailing Address - Fax:787-805-1040
Practice Address - Street 1:CALLE DE DIEGO 12 ESTE
Practice Address - Street 2:EDIFICIO FRONTERA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-1040
Practice Address - Fax:787-805-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58222Medicare PIN
PRU73277Medicare UPIN