Healthcare Provider Details

I. General information

NPI: 1275952897
Provider Name (Legal Business Name): AGUADILLA OPTICAL EYE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE VICTORIA ROAD #2 KM 129.3
AGUADILLA PR
00604-0479
US

IV. Provider business mailing address

PO BOX 250479 BO. VICTORIA
AGUADILLA PR
00604-0479
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-0303
  • Fax: 787-882-0399
Mailing address:
  • Phone: 787-882-0303
  • Fax: 787-882-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MEICY SOFIBEL VARGAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-882-0303