Healthcare Provider Details

I. General information

NPI: 1215201330
Provider Name (Legal Business Name): EYEGLASSES UNLIMITED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 EDIFICIO TORO CYCLE 101 CARR . 100 KM 5.9
CABO ROJO PR
00623-4442
US

IV. Provider business mailing address

2298 EDIFICIO TORO CYCLE 101 CARR . 100 KM 5.9
CABO ROJO PR
00623-4442
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-0484
  • Fax: 787-255-0888
Mailing address:
  • Phone: 787-851-0484
  • Fax: 787-255-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number272
License Number StatePR

VIII. Authorized Official

Name: DR. JORGE G ACEVEDO
Title or Position: OPTOMETRIST/PRESIDENT
Credential: OD
Phone: 787-528-7044