Provider Demographics
NPI:1144287129
Name:VAZQUEZ, JUAN M (OD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:C22 AVE GAUTIER BENITEZ
Mailing Address - Street 2:CONSOLIDATED MALL SUIT 34
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9192
Mailing Address - Country:US
Mailing Address - Phone:787-744-2821
Mailing Address - Fax:787-957-8680
Practice Address - Street 1:C22 AVE GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MALL SUIT 34
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9192
Practice Address - Country:US
Practice Address - Phone:787-744-2821
Practice Address - Fax:787-957-8680
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIB118AMedicare PIN