Stephanie Marie De la Matta, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

747 Issued in PR

Practice address

46 Avenida Universidad Interamericana
San German, PR 00683

Phone

(787) 892-6016

NPI assigned

Dec 10, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• JRSD Eye Care LLC

  • Optometrist
  • Sabana Grande, PR
  • NPI 1881359073
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1083210462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 AVENIDA UNIVERSIDAD INTERAMERICANA",
            "city": "SAN GERMAN",
            "state": "PR",
            "postal_code": "00683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 AVENIDA UNIVERSIDAD INTERAMERICANA",
            "city": "SAN GERMAN",
            "state": "PR",
            "postal_code": "00683",
            "telephone_number": "787-892-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA MATTA",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-10",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PR",
            "license": "747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramon A. Davila Ortiz, M.D.
• Alerys Marie De Jesus Rodriguez
• Paola Andrea De Jesus
• Ramon De Jesus, M.D.
• De la Mano Nursing Home
• Dento-Lab, Inc
• Dento-Medics, CSP
• Dento-Ped, CSP
• Dermatologics LLC
• Wigmar Diaz Ramos, PH D

• Optometrist in San German, PR
• Providers in San German, PR by specialty
• Optometrist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.

Verify at the official NPI Registry.