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General NPI Number Information
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NPI Number | 1104626779
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Entity Type | Organization
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Legal Business Name | EYEGLASSES SHOP
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | LAS LOMAS PROFESSIONAL CENTER LOCAL 16 AVE JESUS T. PINEIRO ESQ AVE SAN PATRICIO
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City | SAN JUAN
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State | PR
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Zip | 00921-9998
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Country | US
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Telephone | 939-449-6527
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Fax |
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Provider Business Mailing Address
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Address Line | LAS LOMAS PROFESSIONAL CENTER LOCAL 16 AVE JESUS T. PINEIRO ESQ AVE SAN PATRICIO
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City | SAN JUAN
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State | PR
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Zip | 00921-9998
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Country | US
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Telephone | 939-449-6527
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | RAMIRO REYES
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Credential | LIC
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Telephone | 787-637-2793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 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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