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General NPI Number Information
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NPI Number | 1477133700
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Entity Type | Organization
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Legal Business Name | BAYAMON OPTICAL INC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | CALLE A O15 REPARTO VALENCIA
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-422-9118
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Fax |
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Provider Business Mailing Address
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Address Line | RR 12 BOX 10016
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City | BAYAMON
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State | PR
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Zip | 00956-9643
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Country | US
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Telephone | 787-422-9118
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | LERIEANN MILLAN CRUZ
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Credential |
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Telephone | 787-422-9118
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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 |
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License Number State |
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