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General NPI Number Information
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NPI Number | 1376763060
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Entity Type | Organization
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Legal Business Name | NOVA OPTICAL GROUP CORP
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR. 174 KM 21 BO. MULAS
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City | AGUAS BUENAS
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State | PR
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Zip | 00703
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Country | US
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Telephone | 787-732-1700
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Fax | 787-732-1700
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Provider Business Mailing Address
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Address Line | Q1 CALLE SANTA LUCIA URB. SANTA ELVIRA
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City | CAGUAS
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State | PR
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Zip | 00725-3440
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Country | US
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Telephone | 787-732-1700
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Fax | 787-732-1700
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Authorized Official
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Title or Position | OWNER
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Name | NORA ALCOCER
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Credential |
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Telephone | 787-732-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 582
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License Number State | PR
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