Healthcare Provider Details

I. General information

NPI: 1528972247
Provider Name (Legal Business Name): OPTICA LOTTICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE FRAGOSO ESQUINA CALLE FIDALGO PLAZA CAROLINA LOCAL 1
CAROLINA PR
00985
US

IV. Provider business mailing address

45-12 CALLE 41
CAROLINA PR
00985-5519
US

V. Phone/Fax

Practice location:
  • Phone: 787-619-9958
  • Fax:
Mailing address:
  • Phone: 787-619-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JORGE I RIOS SR.
Title or Position: MANAGER MEMBER
Credential:
Phone: 787-619-9958