Individual provider Active NPI

Jose R Nieto, OD

  • Optometrist
  • Aguadilla, PR
National Provider Identifier
1700817145
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
420 Issued in PR
Practice address
Calle Francisco Altieri #1
Aguadilla, PR 00603
Phone
(787) 891-2205
Fax
(787) 891-2205
NPI assigned
Jul 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 420 PR Primary

Addresses

Primary practice location

Calle Francisco Altieri #1
Aguadilla, PR 00603

Mailing address

Calle Francisco Altieri #1
Aguadilla, PR 00603
Phone (787) 891-2205

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130320000542 PR Practitioner - Optometry 4385889401 Reassigns benefits to 2 organizations
Practice locations: Aguadilla, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
420PRMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
For Eyes Optical of Puerto Rico, LLC CurrentSince Oct 13, 2022 Accepting new patients
Pro Vision Optical Inc Optometrist CurrentSince Feb 1, 2023 Accepting new patients
For Eyes Optical of Puerto Rico, LLC CurrentSince Oct 13, 2022 Accepting new patients

Locations

725 Ave West Main
Ste 600
Bayamon, PR 00961
Phone (787) 966-7473

200 Ave Rafael Cordero
Ste 106
Caguas, PR 00725
Phone (939) 332-7043

Organizations & group practices 3

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700817145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CALLE FRANCISCO ALTIERI #1",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "00603",
            "telephone_number": "787-891-2205",
            "fax_number": "787-891-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE FRANCISCO ALTIERI #1",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "00603",
            "telephone_number": "787-891-2205",
            "fax_number": "787-891-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIETO",
        "first_name": "JOSE",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PR",
            "license": "420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aguadilla, PR

Sources for this page

Verify at the official NPI Registry.