Healthcare Provider Details

I. General information

NPI: 1699356444
Provider Name (Legal Business Name): HIRAM OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE ANTONIO LOPEZ
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 1
HUMACAO PR
00792
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-4255
  • Fax:
Mailing address:
  • Phone: 787-460-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. HIRAM OLMEDA-RODRIGUEZ
Title or Position: OWNER/PRESIDENT
Credential: OP
Phone: 787-460-4255