Healthcare Provider Details

I. General information

NPI: 1417795956
Provider Name (Legal Business Name): VISION WORLD - PLAZA GUAYNABO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 06/10/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE MARTINEZ NADAL LOT 22 PLAZA GUAYNABO SHOP CTER
GUAYNABO PR
00965-5301
US

IV. Provider business mailing address

8 CALLE BENITO FEIJOO URB VILLAS DEL ESTE
SAN JUAN, PR PR
00926-6900
US

V. Phone/Fax

Practice location:
  • Phone: 939-353-4583
  • Fax: 939-353-4583
Mailing address:
  • Phone: 939-353-4583
  • Fax: 787-731-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: SORAYA LUGO SANTIAGO
Title or Position: PRESIDENT
Credential:
Phone: 939-353-4583