Active NPI
Marisel Irizarry Lugo, OD
- Optometrist
- San German, PR
National Provider Identifier
1316085368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 587
- Practice address
- San German Medical Plaza
Suite 105
San German, PR 00638 - Phone
- (787) 264-3830
- Fax
- (787) 264-3830
- NPI assigned
- Feb 2, 2007
- Last updated
- Jul 9, 2007
- Sex
- Female
- 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 | 587 | PR | Primary |
Addresses
Primary practice location
San German Medical Plaza
Suite 105
San German, PR 00638
Mailing address
PO Box 63
Sabana Grande, PR 00637-0063
Phone (787) 487-0890
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 |
|---|---|---|---|---|
| I20160502001405 | PR | Order and Referring Only - Optometry | 2062488372 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 587 | PR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1316085368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 63",
"city": "SABANA GRANDE",
"state": "PR",
"postal_code": "006370063",
"telephone_number": "787-487-0890",
"fax_number": "787-264-3830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SAN GERMAN MEDICAL PLAZA",
"address_2": "SUITE 105",
"city": "SAN GERMAN",
"state": "PR",
"postal_code": "00638",
"telephone_number": "787-264-3830",
"fax_number": "787-264-3830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRIZARRY LUGO",
"first_name": "MARISEL",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PR",
"license": "587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San German, PR
- Instituto Hiperbarico, Inc.
- Integrated Cardiovascular Services Group LLC
- Intellectual Therapy Services LLC
- Inter American University of Puerto Rico
- Maritza Margarita Irizarry Colon, M.D.
- Juan Isaac Irizarry Nieves, MD
- Ana Ivette Irizarry-Toro, MA
- Daniel A Irizarry
- Ronaldo Irizarry, M.D.
- Tayliss Irizarry
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.