1780722454 NPI number — MAYAGUEZ OPTICAL LAB INC

Table of content: (NPI 1780722454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780722454 NPI number — MAYAGUEZ OPTICAL LAB INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYAGUEZ OPTICAL LAB INC
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:
1780722454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 CALLE PERAL EDIFICIO LA PALMA
Provider Second Line Business Mailing Address:
1A
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-2492
Provider Business Mailing Address Fax Number:
787-265-2190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE PERAL #14 EDIFICIO LA PALMA
Provider Second Line Business Practice Location Address:
OFICINA 1A
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-2492
Provider Business Practice Location Address Fax Number:
787-265-2190
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-834-2492

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780722454 . This is a "MEDICAL CARD SYSTEM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00083 . This is a "VISION HEMISFERICA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0945 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1780722454 . This is a "SEGUROS DE SERVICIOS DE SALUD- SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1823-5 . This is a "PROSSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1780722454 . This is a "MAPFRE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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