Healthcare Provider Details

I. General information

NPI: 1710250980
Provider Name (Legal Business Name): RUAH OPTICAL GALLERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MULTISERVICIO 115 ST KM 246
AGUADA PR
00602
US

IV. Provider business mailing address

115 ST KM 246 BO ASOMANTE
AGUADA PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-365-0166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: OMAYRA IVETTE ORTIZ
Title or Position: OWNER
Credential:
Phone: 787-365-0166