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General NPI Number Information
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NPI Number | 1063608685
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Entity Type | Organization
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Legal Business Name | AUTENTIC SUNGLASESS & OPTICAL
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | HC 20 BOX 11066
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City | JUNCOS
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State | PR
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Zip | 00777-9637
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Country | US
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Telephone | 787-743-0215
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Fax | 787-743-0215
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Provider Business Mailing Address
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Address Line | AVE. RAFAEL COLDERO PLAZA CENTRO MALL1 L-K-9
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City | CAGUAS
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State | PR
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Zip | 00777-9657
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Country | US
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Telephone | 787-743-0215
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Fax | 787-743-0215
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NAYDA I DELGADO
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Credential |
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Telephone | 787-743-0215
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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 | 795
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License Number State | PR
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