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General NPI Number Information
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NPI Number | 1295160125
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Entity Type | Organization
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Legal Business Name | URBAN OPTIC SHOP
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 281A CALLE CLEMSON UNIVERSITY GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00927-4127
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Country | US
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Telephone | 787-502-4910
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Fax |
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Provider Business Mailing Address
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Address Line | CLEMSON 281-A UNIVERSITY GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00927-4020
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Country | US
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Telephone | 787-502-4910
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WANDA SANGIOVANNI
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Credential | O.D.
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Telephone | 787-502-4910
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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 |
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License Number State |
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