Vanessa Marie Cordova, OD
Individual provider Active NPI Optometrist · Canovanas, PR
NPI 1457097412 · NPPES record last updated Jul 12, 2022
Key facts
- NPI
- 1457097412
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 757 (PR)
- Practice address
- Carr 3 KM 19.9 East Medical Professional Center
Canovanas, PR 00738 - Phone
- (787) 256-6060
- NPI assigned
- May 11, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 757 | PR | Yes |
Addresses
Primary practice location
Carr 3 KM 19.9 East Medical Professional Center
Canovanas, PR 00738
Mailing address
PO Box 2282
Canovanas, PR 00729-2282
Phone (787) 256-6060
Other practice location 1
11 Calle Jorge Bird Leon W
Fajardo, PR 00738-5220
Phone (787) 860-6060
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 757 | Other | PR | LICENSE OD |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | bodylamp33@gmail.com | Direct |
Other providers in Canovanas, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.