1912653122 NPI number — OPTICA PRISMA

Table of content: (NPI 1912653122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912653122 NPI number — OPTICA PRISMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICA PRISMA
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:
1912653122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 OESTE CALLE DE LA CANDELARIA
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:
00682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-918-1749
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR 402 KM 2.9 BARRIO QUEBRADA LARGA
Provider Second Line Business Practice Location Address:
VALLEY HILLS PROFESSIONAL CENTER SUITE 11
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:
787-918-1749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MERCADO
Authorized Official First Name:
KARINA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-918-1749

Provider Taxonomy Codes

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

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