Healthcare Provider Details

I. General information

NPI: 1902617145
Provider Name (Legal Business Name): FOR EYES OPTICAL OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 AVE MILITAR STE 193
ISABELA PR
00662-4046
US

IV. Provider business mailing address

4000 LUXOTTICA PL ATTN MEDICARE DEPT
MASON OH
45040-8114
US

V. Phone/Fax

Practice location:
  • Phone: 954-205-3412
  • Fax: 855-881-9434
Mailing address:
  • Phone: 954-205-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIM GRIFFIN
Title or Position: SR ANALYST
Credential:
Phone: 954-205-3412