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General NPI Number Information
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NPI Number | 1346573458
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Entity Type | Organization
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Legal Business Name | LOVE YOUR EYES OPTICALINC
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | EMMANUELLI 215 DAVILA Y LLENZA
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-603-3601
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Fax |
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Provider Business Mailing Address
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Address Line | CARR 861 # KM6.4
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City | TOA ALTA
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State | PR
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Zip | 00953-8528
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Country | US
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Telephone | 787-603-3601
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUTH M ORTIZ
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Credential | OPTOMETRIST
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Telephone | 787-603-3601
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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 | 456
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License Number State | PR
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