Provider Demographics
NPI:1730537812
Name:CENTRO OFTALMOLOGICO Y CIRUGIA OCULOFACIAL COCO
Entity type:Organization
Organization Name:CENTRO OFTALMOLOGICO Y CIRUGIA OCULOFACIAL COCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON-ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-645-0897
Mailing Address - Street 1:596 CALLE AUSTRAL
Mailing Address - Street 2:APT 4B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4203
Mailing Address - Country:US
Mailing Address - Phone:787-645-0897
Mailing Address - Fax:
Practice Address - Street 1:102 CALLE CENTRAL
Practice Address - Street 2:CENTERPLEX BLDG SUITE 309
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-8696
Practice Address - Country:US
Practice Address - Phone:787-645-0897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-30
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18537261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery