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General NPI Number Information
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NPI Number | 1326389818
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Entity Type | Organization
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Legal Business Name | HOPTICAL
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | CARR. 172, URB. TURABO GARDENS HOSPITAL MENONITA CAGUAS, PRIMER PISO
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-637-0834
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Fax |
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Provider Business Mailing Address
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Address Line | 423 CALLE SAN JULIAN URB. SAGRADO CORAZON
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City | SAN JUAN
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State | PR
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Zip | 00926-4243
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Country | US
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Telephone | 787-637-0834
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. GRACE M WILEY
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Credential | O.D.
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Telephone | 787-637-0834
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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 | 464
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 464
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License Number State | PR
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