Healthcare Provider Details

I. General information

NPI: 1952259061
Provider Name (Legal Business Name): OPTICA DE DIEGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CALLE DE DIEGO E
MAYAGUEZ PR
00680-5499
US

IV. Provider business mailing address

109 CALLE DE DIEGO E
MAYAGUEZ PR
00680-5499
US

V. Phone/Fax

Practice location:
  • Phone: 787-225-5231
  • Fax:
Mailing address:
  • Phone: 787-225-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARYSELMA MUNIZ ROBLES
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-562-5261