=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477199313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTI-VISION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2019
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE JOSE M TORO BASORA #4
-----------------------------------------------------
City | LAJAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-899-1800
-----------------------------------------------------
Fax | 787-899-1800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 227
-----------------------------------------------------
City | LAJAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-899-1800
-----------------------------------------------------
Fax | 787-899-1800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TECNICA OFTALMICA
-----------------------------------------------------
Name | IVONNE IRILARRY LUGO SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-899-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------