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General NPI Number Information
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NPI Number | 1093910952
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Entity Type | Organization
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Legal Business Name | EYE LAND OPTICAL INC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | STREET 110 KM 0.3
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-882-4189
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Fax | 787-882-0562
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Provider Business Mailing Address
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Address Line | PO BOX 250431
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City | AGUADILLA
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State | PR
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Zip | 00604-0431
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Country | US
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Telephone | 787-882-4189
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Fax | 787-882-0562
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAUL E LOPEZ
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Credential | M.D.
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Telephone | 787-882-4189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number | 14569
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License Number State | PR
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