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General NPI Number Information
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NPI Number | 1447470943
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Entity Type | Organization
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Legal Business Name | IQ OPTICAL INC
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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 | PMB 627 BOX 4952
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City | CAGUAS
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State | PR
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Zip | 00726
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Country | US
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Telephone | 787-286-6362
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Fax | 787-286-6364
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Provider Business Mailing Address
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Address Line | PMB 627 PO BOX 4952
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City | CAGUAS
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State | PR
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Zip | 00726
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Country | US
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Telephone | 787-286-6362
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Fax | 787-286-6364
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Authorized Official
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Title or Position | ADMINISTRADOR
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Name | MRS. YADIRA CALDERIN
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Credential |
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Telephone | 787-286-6362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 455
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License Number State | PR
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