Healthcare Provider Details

I. General information

NPI: 1659715720
Provider Name (Legal Business Name): OPTICA L.M. , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 863 KM 1.2 BO PAJAROS
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 703
TOA BAJA PR
00951-0703
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-0575
  • Fax: 787-798-0575
Mailing address:
  • Phone: 787-798-0575
  • Fax: 787-798-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number609
License Number StatePR

VIII. Authorized Official

Name: CAROL MALDONADO
Title or Position: PRESIDENT
Credential:
Phone: 787-798-0575