Healthcare Provider Details

I. General information

NPI: 1750136974
Provider Name (Legal Business Name): J.M. OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO STE 402
BAYAMON PR
00961-7022
US

IV. Provider business mailing address

100 PASEO SAN PABLO STE 402
BAYAMON PR
00961-7022
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-1900
  • Fax:
Mailing address:
  • Phone: 787-784-1900
  • 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: DR. JOSE R. MIRANDA RIVERA
Title or Position: OWNER
Credential: M. D.
Phone: 787-269-3715