Healthcare Provider Details

I. General information

NPI: 1215740915
Provider Name (Legal Business Name): 20/20 OPTICAL, JEIRA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 CALLE MORSE LOCAL 2
ARROYO PR
00714
US

IV. Provider business mailing address

55 JOSE DE DIEGO
CIDRA PR
00739-3241
US

V. Phone/Fax

Practice location:
  • Phone: 787-558-5286
  • Fax:
Mailing address:
  • Phone: 787-714-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRASEMA LABOY
Title or Position: PRESIDENT/OWNER
Credential: OP
Phone: 787-714-4550