Provider Demographics
NPI:1902951262
Name:COLON, AURILISSE (OD)
Entity Type:Individual
Prefix:DR
First Name:AURILISSE
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE B
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1911
Mailing Address - Country:US
Mailing Address - Phone:787-857-1807
Mailing Address - Fax:787-857-1807
Practice Address - Street 1:2 CALLE B
Practice Address - Street 2:SUITE 1
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1911
Practice Address - Country:US
Practice Address - Phone:787-857-1807
Practice Address - Fax:787-857-1807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist