Healthcare Provider Details

I. General information

NPI: 1780172148
Provider Name (Legal Business Name): CRUZ OPTICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

HC 2 BOX 5380
LARES PR
00669-9703
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-2599
  • Fax:
Mailing address:
  • Phone: 787-383-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JAIME CRUZ
Title or Position: PRESIDENT/ TREASURER
Credential:
Phone: 787-614-2599