Healthcare Provider Details

I. General information

NPI: 1255156642
Provider Name (Legal Business Name): ENFOQUE OPTICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE DEGETAU S # 103
AIBONITO PR
00705-3637
US

IV. Provider business mailing address

HC 2 BOX 9956
AIBONITO PR
00705-9654
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-6139
  • Fax:
Mailing address:
  • Phone: 787-420-6139
  • 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: MRS. LYDIA D BURGOS ALICEA
Title or Position: OWNER
Credential:
Phone: 787-420-6139