Healthcare Provider Details

I. General information

NPI: 1538686605
Provider Name (Legal Business Name): JK OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CARR CENTRO COMERCIAL SAN JOSE LOCAL #13
HUMACAO PR
00791
US

IV. Provider business mailing address

HC 1 BOX 167691
HUMACAO PR
00791-9073
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-3124
  • Fax:
Mailing address:
  • Phone: 787-201-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StatePR

VIII. Authorized Official

Name: KYRIAM MICHELLE RIOS
Title or Position: PRESIDENTA
Credential: OPTICO
Phone: 787-201-0524