Healthcare Provider Details

I. General information

NPI: 1699092767
Provider Name (Legal Business Name): BORINQUEN VISION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAROLINA SHOPP CTR
CAROLINA PR
00985-5672
US

IV. Provider business mailing address

PLAZA CAROLINA LOCAL 245
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-701-3165
  • Fax: 787-701-3168
Mailing address:
  • Phone: 787-701-3165
  • Fax: 787-701-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number661
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS R RUIZ
Title or Position: PRESIDENT
Credential:
Phone: 787-701-3165