1487999116 NPI number — VISUAL HEALERS OPTICA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487999116 NPI number — VISUAL HEALERS OPTICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISUAL HEALERS OPTICA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487999116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CONDOMINIO LAGO PLAYA 3000 CALLE CORAL
Provider Second Line Business Mailing Address:
APT 3012
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-460-5937
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 2 J 20 EXT HNAS DAVILA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-460-5937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NIEVES
Authorized Official First Name:
RUBEN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
787-460-5937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  589 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)