=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356581623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFETY LENS & EYEWEAR INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2009
-----------------------------------------------------
Last Update Date | 02/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB. PARK HURST GARDEN 1ST FLOOR A2
-----------------------------------------------------
City | LAS PIEDRAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-632-9333
-----------------------------------------------------
Fax | 787-736-1676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AVE JESUS T. PINERO 1ST FLOOR A 2
-----------------------------------------------------
City | LAS PIEDRAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-632-9333
-----------------------------------------------------
Fax | 787-736-1676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN
-----------------------------------------------------
Name | MR. EFRAIN DOMINGUEZ
-----------------------------------------------------
Credential | OP
-----------------------------------------------------
Telephone | 787-632-9333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------