Healthcare Provider Details

I. General information

NPI: 1700479706
Provider Name (Legal Business Name): J & F OPTICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR # 2 CENTRO GRAN CARIBE MALL
VEGA ALTA PR
00646
US

IV. Provider business mailing address

PMB 333 P.O.BOX 7891
GUAYNABO PR
00970
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-4646
  • Fax:
Mailing address:
  • Phone: 787-648-0457
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: FRANCIS D MEDINA
Title or Position: OWNER
Credential:
Phone: 787-782-2175