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General NPI Number Information
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NPI Number | 1295109239
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Entity Type | Organization
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Legal Business Name | LANES ENTERPRISES INC
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | PLAZA SAN MIGUEL SUITE 102 EXPRESO TRUJILLO ALTO.
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-755-7077
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Fax | 787-283-7077
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Provider Business Mailing Address
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Address Line | PO BOX 1151
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977-1151
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Country | US
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Telephone | 787-755-7077
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Fax | 787-283-7077
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Authorized Official
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Title or Position | OWNER
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Name | DR. OSVALDO CARRILES
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Credential | OD.
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Telephone | 787-755-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | PR.#184-0077
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License Number State | PR
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