Healthcare Provider Details

I. General information

NPI: 1497729149
Provider Name (Legal Business Name): OLIMPIA VARGAS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2 H48 MARGINAL SANTA RITA
SAN JUAN PR
00692
US

IV. Provider business mailing address

H48 MARGINAL SANTA RITA CARR. #2
SAN JUAN PR
00692
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-1859
  • Fax: 787-883-7692
Mailing address:
  • Phone: 787-883-1859
  • Fax: 787-883-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number145
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: