Healthcare Provider Details

I. General information

NPI: 1972600534
Provider Name (Legal Business Name): HIRAM OLMEDA OPTICO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE ANTONIO LOPEZ
HUMACAO PR
00791-4224
US

IV. Provider business mailing address

PO BOX 1
HUMACAO PR
00792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-4255
  • Fax: 787-285-1250
Mailing address:
  • Phone: 787-460-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number488
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: