Healthcare Provider Details

I. General information

NPI: 1841414265
Provider Name (Legal Business Name): SMART VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#11 PASEO CASA BLANCA
VEGA BAJA PR
00693
US

IV. Provider business mailing address

#11 PASEO CASA BLANCA
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-596-5297
  • Fax: 787-807-1581
Mailing address:
  • Phone: 787-596-5297
  • Fax: 787-807-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number575
License Number StatePR

VIII. Authorized Official

Name: ZASKIA MONTES
Title or Position: OPTICIAN
Credential:
Phone: 787-596-5297