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General NPI Number Information
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NPI Number | 1053081190
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Entity Type | Organization
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Legal Business Name | OPTIQUS VISION DORADO
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | PASEO DEL PLATA SHOPPING CENTER AVE JOSE EFRON EDIFICIO 10A
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-300-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 1023 CALLE GUAJATACA
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City | CAGUAS
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State | PR
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Zip | 00725-7631
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Country | US
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Telephone | 787-300-0166
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXIS DANIEL GARCIA PALOU
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Credential |
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Telephone | 787-300-0166
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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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