Healthcare Provider Details

I. General information

NPI: 1770173601
Provider Name (Legal Business Name): THE OPTICS SHOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/11/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 AVE PABLO J. AGUILAR SUITE 2 ALTOS
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 25
HATILLO PR
00659
US

V. Phone/Fax

Practice location:
  • Phone: 787-609-6767
  • Fax: 787-544-8080
Mailing address:
  • Phone: 787-269-6767
  • Fax: 787-544-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JULIO E SOTO CORREA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-696-6767