Healthcare Provider Details

I. General information

NPI: 1528937372
Provider Name (Legal Business Name): EYEMART PR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CC36 CALLE CEIBAS
BAYAMON PR
00961-3419
US

IV. Provider business mailing address

64 AVE.CONDADO PLAZA DEL CONDADO APTO.904
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3333
  • Fax:
Mailing address:
  • Phone: 787-674-7749
  • 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: WILDA IVETTE SANTIAGO
Title or Position: OPTOMETRIST
Credential: OD
Phone: 787-674-7749