Healthcare Provider Details

I. General information

NPI: 1316854128
Provider Name (Legal Business Name): LORENA VISION CENTER OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #3 KM 43.3 PLAZA FAJARDO WALMART VISION CENTE
FAJARDO PR
00738
US

IV. Provider business mailing address

3350 WHITTIER BLVD
LOS ANGELES CA
90023-2206
US

V. Phone/Fax

Practice location:
  • Phone: 626-252-1702
  • Fax: 626-252-1702
Mailing address:
  • Phone: 626-252-1702
  • Fax: 626-252-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LUIS MIGUEL PEREZ
Title or Position: OWNER
Credential: PEREZ
Phone: 626-252-1702