Healthcare Provider Details

I. General information

NPI: 1619961406
Provider Name (Legal Business Name): JOSE LUIS KEY OYOLA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#3 DEGETAU AIBONITO PR AIBONITO OPTICAL
AIBONITO PR
00705
US

IV. Provider business mailing address

434 CALLE APENINOS
SAN JUAN PR
00920-4127
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-0043
  • Fax: 787-735-0043
Mailing address:
  • Phone: 787-342-3555
  • Fax: 787-735-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number387
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: