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General NPI Number Information
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NPI Number | 1497811491
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Entity Type | Organization
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Legal Business Name | VISUAL GALLERY P.S.C.
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | AVE. NATIVO ALERS EDIFICIO FARMACIA SAN ANTONIO
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-868-2181
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Fax | 787-868-2181
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Provider Business Mailing Address
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Address Line | HC 56 BOX 35640
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City | AGUADA
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State | PR
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Zip | 00602-9787
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Country | US
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Telephone | 787-868-2181
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Fax | 787-868-2181
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Authorized Official
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Title or Position | OPTOMETRY PRESIDENT
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Name | DR. HEIDI A VILLANUEVA
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Credential | O.D.
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Telephone | 787-868-2181
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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 | 597
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License Number State | PR
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