Cordobesa LLC
Organization Active NPI Optometrist · Morovis, PR
NPI 1831880178 · NPPES record last updated May 23, 2024
Key facts
- NPI
- 1831880178
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- CORDOBESA LLC
- Practice address
- 2092 Carr 633 Bo Barahona
Morovis, PR 00687 - Phone
- (787) 369-2400
- NPI assigned
- May 17, 2023
- Organization subpart
- No
Authorized official
- Name
- Maria D Camacho Peinado
- Title
- President
- Phone
- (787) 369-2400
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230824003638 | PR | Part B Supplier - Clinic/Group Practice | 5698138592 |
Receives reassigned benefits from 1 practitioner Practice locations: Morovis, PR |
National Provider Directory
Locations
2092 Carr 633
Morovis, PR 00687
Phone (787) 369-2400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Eyewear Supplier | 332H00000X |
Addresses
Primary practice location
2092 Carr 633 Bo Barahona
Morovis, PR 00687
Mailing address
PO Box 190399
San Juan, PR 00919-0399
Other providers in Morovis, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.