1780277780 NPI number — M&M OPTICAL SHOP CORP

Table of content: (NPI 1780277780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780277780 NPI number — M&M OPTICAL SHOP CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M&M OPTICAL SHOP CORP
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:
1780277780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 333 P.O.BOX 7891
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-648-0457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LOS ROMEROS
Provider Second Line Business Practice Location Address:
THE OUTLET'S @ MONTEHIEDRA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-287-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEDINA
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
877-625-9144

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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