1851895874 NPI number — CENTRO OPTOMETRICO ESPECIALIZADO DE PR LLC

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 1851895874 NPI number — CENTRO OPTOMETRICO ESPECIALIZADO DE PR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO OPTOMETRICO ESPECIALIZADO DE PR LLC
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:
1851895874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BAYAMON MEDICAL BUILDING
Provider Second Line Business Mailing Address:
J23 AVE BETANCES URB HERMANAS DAVILA
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-200-5527
Provider Business Mailing Address Fax Number:
787-779-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ESTANCIAS DE RIO HONDO III
Provider Second Line Business Practice Location Address:
CC36 CALLE CEIBAS
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-3333
Provider Business Practice Location Address Fax Number:
787-779-3900
Provider Enumeration Date:
03/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
WILDA
Authorized Official Middle Name:
IVETTE
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
787-200-5527

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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