Healthcare Provider Details

I. General information

NPI: 1205986056
Provider Name (Legal Business Name): OHI OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA ROSA MALL LOCAL #7
BAYAMON PR
00959-6710
US

IV. Provider business mailing address

275 ROUTE 22
SPRINGFIELD NJ
07081-3554
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-6334
  • Fax:
Mailing address:
  • Phone: 917-716-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ISAIAS CALDERON
Title or Position: SPECIALIST
Credential:
Phone: 787-925-1851