Healthcare Provider Details

I. General information

NPI: 1598915456
Provider Name (Legal Business Name): LA NUEVA OPTICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CALLE MUNOZ RIVERA
TOA ALTA PR
00953-2418
US

IV. Provider business mailing address

34 CALLE MUNOZ RIVERA
TOA ALTA PR
00953-2418
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-2960
  • Fax: 787-870-7257
Mailing address:
  • Phone: 787-870-2960
  • Fax: 787-870-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number755
License Number StatePR

VIII. Authorized Official

Name: MRS. CHRISTINE M. MALLENS
Title or Position: OWNER
Credential: LICENCIADA
Phone: 787-870-2960