1962626705 NPI number — ETTIENNE LUGO DELGADO

Table of content: (NPI 1962626705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962626705 NPI number — ETTIENNE LUGO DELGADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ETTIENNE LUGO DELGADO
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:
DBA ACCU VISION
Provider Other Organization Name Type Code:
3
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:
1962626705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 CALLE HOLLYWOOD DR
Provider Second Line Business Mailing Address:
URB. HOLLYWOOD ESTATES BO. QUEBRADA ARENAS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-262-1486
Provider Business Mailing Address Fax Number:
787-262-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE LUIS MUNOZ RIVERA 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMUY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00627-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-262-1486
Provider Business Practice Location Address Fax Number:
787-262-1486
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUGO
Authorized Official First Name:
ETTIENNE
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF OPTOMETRY
Authorized Official Telephone Number:
787-262-1486

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  573 , 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)