Healthcare Provider Details

I. General information

NPI: 1770282980
Provider Name (Legal Business Name): WD VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AVE LAS CUMBRES SUITE 104
GUAYNABO PR
00969-4836
US

IV. Provider business mailing address

10 AVE LAS CUMBRES SUITE 104
GUAYNABO PR
00969-4836
US

V. Phone/Fax

Practice location:
  • Phone: 787-513-4187
  • Fax: 787-258-8225
Mailing address:
  • Phone: 787-513-4187
  • Fax: 787-258-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. WILFREDO CRUZ
Title or Position: PRESIDENT/OWNER
Credential: OD
Phone: 787-513-4187