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General NPI Number Information
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NPI Number | 1255156642
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Entity Type | Organization
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Legal Business Name | ENFOQUE OPTICO LLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1 CALLE DEGETAU S # 103
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City | AIBONITO
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State | PR
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Zip | 00705-3637
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Country | US
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Telephone | 787-420-6139
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 9956
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City | AIBONITO
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State | PR
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Zip | 00705-9654
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Country | US
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Telephone | 787-420-6139
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYDIA D BURGOS ALICEA
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Credential |
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Telephone | 787-420-6139
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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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