Healthcare Provider Details

I. General information

NPI: 1477199313
Provider Name (Legal Business Name): OPTI-VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 12/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE M TORO BASORA #4
LAJAS PR
00667
US

IV. Provider business mailing address

P.O. BOX 227
LAJAS PR
00667
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-1800
  • Fax: 787-899-1800
Mailing address:
  • Phone: 787-899-1800
  • Fax: 787-899-1800

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: IVONNE IRILARRY LUGO SR.
Title or Position: TECNICA OFTALMICA
Credential:
Phone: 787-899-1800