Healthcare Provider Details

I. General information

NPI: 1124494927
Provider Name (Legal Business Name): OHI OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2015
Last Update Date: 08/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 AVE MIRAMAR PLAZA DEL ATLANTICO STE 154
ARECIBO PR
00612-2894
US

IV. Provider business mailing address

275 ROUTE 22
SPRINGFIELD NJ
07081-3554
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KAREN LEMER
Title or Position: BILLER
Credential:
Phone: 847-309-0098