Healthcare Provider Details

I. General information

NPI: 1568122653
Provider Name (Legal Business Name): INFINITY EYE VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALTURAS DE RIO GRANDE AA21 CALLE D
RIO GRANDE PR
00745-3324
US

IV. Provider business mailing address

PO BOX 43002 STE 114
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-657-0338
  • Fax: 787-468-0846
Mailing address:
  • Phone: 787-657-0338
  • Fax: 787-468-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH LOPEZ RUIZ
Title or Position: PRESIDENT
Credential:
Phone: 787-349-6166