Healthcare Provider Details

I. General information

NPI: 1326389818
Provider Name (Legal Business Name): HOPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 172, URB. TURABO GARDENS HOSPITAL MENONITA CAGUAS, PRIMER PISO
CAGUAS PR
00725
US

IV. Provider business mailing address

423 CALLE SAN JULIAN URB. SAGRADO CORAZON
SAN JUAN PR
00926-4243
US

V. Phone/Fax

Practice location:
  • Phone: 787-637-0834
  • Fax:
Mailing address:
  • Phone: 787-637-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number464
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number464
License Number StatePR

VIII. Authorized Official

Name: DR. GRACE M WILEY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 787-637-0834