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General NPI Number Information
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NPI Number | 1477949154
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Entity Type | Organization
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Legal Business Name | I LOOK OPTICAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 60 CALLE GEORGETTI SUITE 1A
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City | RIO PIEDRAS
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State | PR
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Zip | 00925-3607
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Country | US
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Telephone | 787-765-0039
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Fax | 787-765-0039
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Provider Business Mailing Address
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Address Line | PO BOX 192173
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City | SAN JUAN
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State | PR
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Zip | 00919-2173
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Country | US
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Telephone | 787-765-0039
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Fax | 787-765-0039
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MORAIMA DE LOURDES NEGRON
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Credential | O.D.
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Telephone | 787-505-1184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 588
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License Number State | PR
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