1063632305 NPI number — SERVICIOS OPTOMETRICOS CSP

Table of content: (NPI 1063632305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063632305 NPI number — SERVICIOS OPTOMETRICOS CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS OPTOMETRICOS CSP
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:
6
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:
1063632305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 628
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-826-6540
Provider Business Mailing Address Fax Number:
787-826-6520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. #2, EDIFICIO B , MULTIPLAZA PR
Provider Second Line Business Practice Location Address:
SUITE #6 BO. CARACOL, KM. 143.3
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-826-6540
Provider Business Practice Location Address Fax Number:
787-826-6520
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEPULVEDA
Authorized Official First Name:
ERNESTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-826-6540

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  160 , 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 © 2007-2025 www.npivalidator.com