1346596806 NPI number — A&S OPTICAL, PSC

Table of content: (NPI 1346596806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346596806 NPI number — A&S OPTICAL, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A&S OPTICAL, PSC
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:
A&S OPTICAL VISUAL CLINIC
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:
1346596806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 CALLE CRUZ ORTIZ STELLA STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-428-1140
Provider Business Mailing Address Fax Number:
877-496-5503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 CALLE CRUZ ORTIZ STELLA STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-428-1140
Provider Business Practice Location Address Fax Number:
877-496-5503
Provider Enumeration Date:
08/01/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALVARADO
Authorized Official First Name:
ILIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
787-367-6238

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  674 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 650 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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