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General NPI Number Information
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NPI Number | 1477209690
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Entity Type | Organization
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Legal Business Name | MODO OPTICO LLC
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | SUITE 1B CALLE 1 AX-1 PRADERA NORTE URB LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949-9999
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Country | US
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Telephone | 939-405-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 143 URB LAS PALMAS DE CERRO GORDO
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 939-405-4799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MONICA SANTIAGO
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Credential |
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Telephone | 939-405-4799
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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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