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General NPI Number Information
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NPI Number | 1447376322
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Entity Type | Organization
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Legal Business Name | ECOVISION OPTICAL SERVICES INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | DOLORES CABRERA STREET 2 #2 WEST
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City | HUMACAO
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State | PR
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Zip | 00792
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Country | US
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Telephone | 787-852-1808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5234
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City | CAGUAS
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State | PR
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Zip | 00726-5234
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Country | US
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Telephone | 787-852-1808
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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. ZAHIRA I. DAVILA
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Credential | OD
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Telephone | 787-852-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 287
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License Number State | PR
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