1720293954 NPI number — LC OPTICAL VISION CENTER

Table of content: (NPI 1720293954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720293954 NPI number — LC OPTICAL VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LC OPTICAL VISION CENTER
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:
1720293954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MANSIONES DEL CARIBE 55 CALLE JADE
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-380-6715
Provider Business Mailing Address Fax Number:
787-839-2131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO COOP MAUNA COOP
Provider Second Line Business Practice Location Address:
CARR 3 INT. 178
Provider Business Practice Location Address City Name:
ARROYO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-839-2131
Provider Business Practice Location Address Fax Number:
787-839-2131
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTRO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
787-839-2131

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  540 , 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: MMM . This is a "890162" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7140015 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PR0540 . This is a "EYE MED VISION CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 100030 . This is a "LA CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: TRIPLE S . This is a "62541" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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