1063861235 NPI number — PRO VISTA INC.

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 1063861235 NPI number — PRO VISTA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO VISTA INC.
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:
1063861235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00745-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 185 KM 5.0
Provider Second Line Business Practice Location Address:
CAMPO RICO
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-886-8066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
O'FARRILL
Authorized Official First Name:
NORA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
787-886-8066

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  299 , 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)





Copyright © 2007-2024 www.npivalidator.com