Healthcare Provider Details

I. General information

NPI: 1033834932
Provider Name (Legal Business Name): OPTIMA VISION 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65 INANTERIA LOS COLOBOS SHOPPING CENTER CARR. #3 KM 14 LOCAL 15
CAROLINA PR
00987
US

IV. Provider business mailing address

URB. CIUDAD JARDIN 19 CALLE GLADIOLA
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-368-5905
  • Fax: 787-769-5900
Mailing address:
  • Phone: 787-368-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANGEL MARIN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 787-368-5905