Healthcare Provider Details

I. General information

NPI: 1306989447
Provider Name (Legal Business Name): WILSON MENDEZ OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DBA OPTICA GUANICA

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 25 DE JULIO #75-C
GUANICA PR
00653-2901
US

IV. Provider business mailing address

CALLE 25 DE JULIO #75-C
GUANICA PR
00653-2901
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-1355
  • Fax:
Mailing address:
  • Phone: 787-821-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number090
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number090
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: