Healthcare Provider Details

I. General information

NPI: 1528047446
Provider Name (Legal Business Name): JTR OPTICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD #3 KM 20.5 PLAZA NORESTE JTR OPTICAL CENTER
CANOVANAS PR
00729
US

IV. Provider business mailing address

PO BOX 1266
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-256-6110
  • Fax: 787-256-6110
Mailing address:
  • Phone: 787-256-6110
  • Fax: 787-256-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JOEL A TORRES
Title or Position: DOCTOR
Credential:
Phone: 787-256-6100