Healthcare Provider Details

I. General information

NPI: 1174918452
Provider Name (Legal Business Name): JC EYES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE 4 DE JULIO
OROCOVIS PR
00720-4431
US

IV. Provider business mailing address

PO BOX 1953
OROCOVIS PR
00720-1953
US

V. Phone/Fax

Practice location:
  • Phone: 787-867-0794
  • Fax:
Mailing address:
  • Phone: 787-845-5272
  • Fax:

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: MYRIAM MARTINEZ
Title or Position: OWNER
Credential: OD
Phone: 787-486-9084