Healthcare Provider Details

I. General information

NPI: 1316415300
Provider Name (Legal Business Name): THE OPTICS SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALLE 2 BO PALENQUE
BARCELONETA PR
00659
US

IV. Provider business mailing address

101 CALLE 2 BO PALENQUE
BARCELONETA PR
00659
US

V. Phone/Fax

Practice location:
  • Phone: 787-960-2525
  • Fax: 787-822-5050
Mailing address:
  • Phone: 787-960-2525
  • Fax: 787-822-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
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. JULIO E SOTO
Title or Position: OWNER
Credential:
Phone: 787-960-2525