Healthcare Provider Details

I. General information

NPI: 1225306145
Provider Name (Legal Business Name): OPTICA MENDEZ INC. DBA VISTAOPTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CALLE SAN EDMUNDO
SAN JUAN PR
00927-6437
US

IV. Provider business mailing address

PO BOX 367476
SAN JUAN PR
00936-7476
US

V. Phone/Fax

Practice location:
  • Phone: 787-457-5727
  • Fax:
Mailing address:
  • Phone: 787-457-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number308
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number308
License Number StatePR

VIII. Authorized Official

Name: PEDRO CUELLAR
Title or Position: PARTNER
Credential:
Phone: 787-457-5727