Active NPI
Edison Marin, O.D.
- Optometrist
- Carolina, PR
National Provider Identifier
1063504439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 393
- Practice address
- 5829 Ave 65 Infanteria Ste 105
Carolina, PR 00987-5008 - Phone
- (787) 276-3435
- Fax
- (787) 276-4835
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 393 | PR | Primary |
Addresses
Primary practice location
5829 Ave 65 Infanteria Ste 105
Carolina, PR 00987-5008
Mailing address
PO Box 361493
San Juan, PR 00936-1493
Phone (787) 276-3435
Other practice location 1
800 Carr 693 Ste 4
Dorado, PR 00646-6707
Phone (787) 796-7373
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190605002293 | PR | Practitioner - Optometry | 4688907744 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726358400000",
"number": "1063504439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 361493",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009361493",
"telephone_number": "787-276-3435",
"fax_number": "787-276-4835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5829 AVE 65 INFANTERIA STE 105",
"city": "CAROLINA",
"state": "PR",
"postal_code": "009875008",
"telephone_number": "787-276-3435",
"fax_number": "787-276-4835"
}
],
"practiceLocations": [
{
"address_1": "800 Carr 693 Ste 4",
"address_purpose": "LOCATION",
"city": "Dorado",
"state": "PR",
"postal_code": "006466707",
"country_code": "US",
"telephone_number": "787-796-7373",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARIN",
"first_name": "EDISON",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2024-09-15",
"certification_date": "2024-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PR",
"license": "393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carolina, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.