| |
200 Ave Fragoso Suite 108, Plaza Carolina Mall, Carolina, PR 00983-3104 | |
(787) 768-6666 | |
(787) 769-6666 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center |
Location | 200 Ave Fragoso Suite 108, Carolina, Puerto Rico |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1972800530 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 135 (Puerto Rico) | Secondary |
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Secondary |
Provider Name | Pedro D Salib |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1619281094 PECOS PAC ID: 0547445074 Enrollment ID: I20110427000732 |
Mailing Address | Practice Location Address |
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90 Parque Medici, Urb Paseo Del Parque, San Juan, PR 00926-6514 Ph: (787) 768-6666 | 200 Ave Fragoso Suite 108, Plaza Carolina Mall, Carolina, PR 00983-3104 Ph: (787) 768-6666 |