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General NPI Number Information
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NPI Number | 1033834932
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Entity Type | Organization
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Legal Business Name | OPTIMA VISION 2 LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | AVE. 65 INANTERIA LOS COLOBOS SHOPPING CENTER CARR. #3 KM 14 LOCAL 15
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-368-5905
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Fax | 787-769-5900
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Provider Business Mailing Address
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Address Line | URB. CIUDAD JARDIN 19 CALLE GLADIOLA
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-368-5905
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. ANGEL MARIN
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Credential |
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Telephone | 787-368-5905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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