Healthcare Provider Details

I. General information

NPI: 1033608492
Provider Name (Legal Business Name): JAIME CRUZ OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE GEORGETTI C-4 EDIFICIO COMERCIAL MARINA,
BARCELONETA PR
00617
US

IV. Provider business mailing address

HC 02 BOX 5380
LARES PR
00669
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-2599
  • Fax:
Mailing address:
  • Phone: 787-614-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number643
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: