1629266606 NPI number — PONCE VISION EXPRESS

Table of content: (NPI 1629266606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629266606 NPI number — PONCE VISION EXPRESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PONCE VISION EXPRESS
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:
1629266606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-872-2977
Provider Business Mailing Address Fax Number:
787-830-3216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA JUAN HERNANDEZ
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL COOP#1
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-872-2977
Provider Business Practice Location Address Fax Number:
787-830-3216
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CABAN
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
ROSA
Authorized Official Title or Position:
LICENSED OPTICIAN
Authorized Official Telephone Number:
787-872-2977

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  153 , 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)

  • Identifier: 051831 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 054595 . This is a "TRIPLES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 583308262 . This is a "MAPFRE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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