Healthcare Provider Details

I. General information

NPI: 1831544253
Provider Name (Legal Business Name): CAGUAS OPTICAL OUTLET, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 AVE MANUEL DOMENECH
SAN JUAN PR
00918-3503
US

IV. Provider business mailing address

PO BOX 191762
SAN JUAN PR
00919-1762
US

V. Phone/Fax

Practice location:
  • Phone: 787-379-7879
  • Fax: 787-282-6956
Mailing address:
  • Phone: 787-379-7879
  • Fax: 787-282-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number666
License Number StatePR

VIII. Authorized Official

Name: JOHANA RODRIGUEZ
Title or Position: PRESIDENT
Credential: O.D
Phone: 787-586-4179