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General NPI Number Information
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NPI Number | 1376952648
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Entity Type | Organization
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Legal Business Name | BEST OPTIC LLC
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 410 CALLE MENDEZ VIGO STE 104
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City | DORADO
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State | PR
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Zip | 00646-4814
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Country | US
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Telephone | 787-796-4155
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Fax | 787-796-3746
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | DORADO
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State | PR
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Zip | 00646-0728
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Country | US
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Telephone | 787-796-4155
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Fax | 787-796-3746
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HECTOR M MAYOL
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Credential | MD
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Telephone | 787-796-4155
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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 | 14577
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License Number State | PR
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