Healthcare Provider Details

I. General information

NPI: 1730940164
Provider Name (Legal Business Name): XPRESS OPTICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 155 KM 66 H 0 BO ALGARROBO
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PMB 138 PO BOX 144035
ARECIBO PR
00614
US

V. Phone/Fax

Practice location:
  • Phone: 787-356-9808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JUAN C RUIZ REYES
Title or Position: OWNER
Credential:
Phone: 787-356-9808