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General NPI Number Information
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NPI Number | 1487957585
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Entity Type | Organization
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Legal Business Name | EYE CARE HOLDING OF PR, INC.
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | CAROLINA SHOPP CTR # 275 AVE. FRAGOSO
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City | CAROLINA
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State | PR
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Zip | 00985-5672
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Country | US
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Telephone | 787-276-1969
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Fax | 787-276-1969
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Provider Business Mailing Address
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Address Line | 401 BLVD MEDIA LUNA #1202
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City | CAROLINA
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State | PR
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Zip | 00987-4954
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Country | US
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Telephone | 787-276-1969
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Fax | 787-276-1969
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSA OJEDA
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Credential | O.D.
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Telephone | 787-276-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 620
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License Number State | PR
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