Healthcare Provider Details

I. General information

NPI: 1033440664
Provider Name (Legal Business Name): CUPEY OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 CALLE SAN CLAUDIO # CUPEY SUITE 110 AVE SAN CLAUDIO 359
SAN JUAN PR
00926-9907
US

IV. Provider business mailing address

SUITE 110 AVE SAN CLAUDIO 359 CUPEY PROFESSIONAL MALL
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-748-8833
  • Fax:
Mailing address:
  • Phone: 787-748-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number387
License Number StatePR

VIII. Authorized Official

Name: MISS ANA EMIL GONZALEZ
Title or Position: OWNER
Credential:
Phone: 787-748-8833