Healthcare Provider Details

I. General information

NPI: 1982948246
Provider Name (Legal Business Name): FERNANDINI OPTICAL GALLERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 AVE LAS BRISAS APT 220 COND MONTEMAR
PONCE PR
00728-5241
US

IV. Provider business mailing address

COND MONTEMAR 1519 AVE LAS BRISAS STE 220
PONCE PR
00728
US

V. Phone/Fax

Practice location:
  • Phone: 787-225-4021
  • Fax:
Mailing address:
  • Phone: 787-225-4021
  • 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: HECTOR L. ORTIZ
Title or Position: OWNER
Credential:
Phone: 787-225-4021