=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023201290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISUAL EYE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2007
-----------------------------------------------------
Last Update Date | 10/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 CALLE CARAZO
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-720-7080
-----------------------------------------------------
Fax | 787-720-7080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 CALLE CARAZO
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-720-7080
-----------------------------------------------------
Fax | 787-720-7080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PEDRO JAVIER MIGENES
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 787-720-7080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------