Healthcare Provider Details

I. General information

NPI: 1598454506
Provider Name (Legal Business Name): YOUR VISION OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CALLE DR CUETO
UTUADO PR
00641-2804
US

IV. Provider business mailing address

URB. VILLA LOS SANTOS C/18 BB 8
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-405-6795
  • Fax:
Mailing address:
  • Phone: 787-405-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIBELLE PAZ
Title or Position: EMPLOYEER
Credential: OPTICIAN
Phone: 787-405-6795