Provider Demographics
NPI:1538461264
Name:WCM VISUAL CARE PSC
Entity type:Organization
Organization Name:WCM VISUAL CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-258-5394
Mailing Address - Street 1:10 CALLE AQUAMARINA
Mailing Address - Street 2:VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1957
Mailing Address - Country:US
Mailing Address - Phone:787-258-5394
Mailing Address - Fax:877-883-4503
Practice Address - Street 1:10 CALLE AQUAMARINA
Practice Address - Street 2:VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1957
Practice Address - Country:US
Practice Address - Phone:787-258-5394
Practice Address - Fax:877-883-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR440-0139332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6411OtherCORPORATE NUMBER