Healthcare Provider Details

I. General information

NPI: 1376636639
Provider Name (Legal Business Name): DORADO VISUAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

410 CALLE MENDEZ VIGO SUITE 201
DORADO PR
00646-4800
US

IV. Provider business mailing address

PO BOX 670
DORADO PR
00646-0670
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-4155
  • Fax: 787-796-3746
Mailing address:
  • Phone: 787-796-4155
  • Fax: 787-796-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number6189
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS R. DEL VALLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-796-4155