Healthcare Provider Details

I. General information

NPI: 1568395150
Provider Name (Legal Business Name): EYE CENTER BOUTIQUE - RIO HONDO MALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 AVE RIO HONDO SUITE B071 RIO HONDO MALL
BAYAMON PR
00961-3106
US

IV. Provider business mailing address

32010 CALLE LIVISTONIA # A-16
DORADO PR
00646-8302
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-0981
  • Fax: 239-231-2948
Mailing address:
  • Phone: 787-261-0981
  • Fax: 239-231-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAR E ALVAREZ CORREA
Title or Position: PRESIDENT
Credential:
Phone: 787-261-0981