Lourdes Ivette Davila Rodriguez, OD
Individual provider Active NPI Optometrist · Coamo, PR
NPI 1699869941 · NPPES record last updated Oct 15, 2018
Key facts
- NPI
- 1699869941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 197 (PR)
- Practice address
- 13 Willie Rosario
Suite 2
Coamo, PR 00769 - Phone
- (787) 825-5458
- Fax
- (787) 803-1993
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
13 Calle Willie Rosario
Suite 2
Coamo, PR 00769-3252
Phone (787) 825-5458
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120402000287 | PR | Practitioner - Optometry | 2163682915 | Practice locations: Coamo, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 197 | PR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preserve Vision LLC | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 197 | PR | Yes |
Addresses
Primary practice location
13 Willie Rosario
Suite 2
Coamo, PR 00769
Mailing address
13 Calle Willie Rosario
Suite 2
Coamo, PR 00769-3252
Phone (787) 825-5458
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58026 | Other | SSS | |
| 2200033 | Other | HUMANA | |
| 38275 | Other | PROSSAM | |
| 660446068 | Other | PR | MAPFRE |
| 660446068 | Other | MCS OPTICA | |
| 890037 | Other | MMM | |
| M000590 | Other | MENONITA |
Other providers in Coamo, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.