Provider Demographics
NPI:1992896971
Name:ROSADO JORDAN, ANGEL MIGUEL (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:MIGUEL
Last Name:ROSADO JORDAN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:CALLE RUIZ BELVIS
Mailing Address - Street 2:# 47
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-743-5785
Mailing Address - Fax:787-743-5785
Practice Address - Street 1:CALLE RUIZ BELVIS
Practice Address - Street 2:# 47
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-5785
Practice Address - Fax:787-743-5785
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR150156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR101263OtherIVISION
PR660533483OtherMCS CLASSICARE