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General NPI Number Information
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NPI Number | 1508049172
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Entity Type | Organization
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Legal Business Name | OPTICAL GALLERY
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | EXPRESSO TRUJILLO CARRT 181 KM 4.0 OPTICAL GALLERY ECONO MEGA 1
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-293-0915
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Fax |
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Provider Business Mailing Address
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Address Line | URB SIERRA BAYAMON CALLE 73 BLQ 85#5
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City | BAYAMON
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State | PR
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Zip | 00961
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Country | US
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Telephone | 787-293-0915
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Fax |
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Authorized Official
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Title or Position | OPTICO
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Name | MR. JAVIER OMAR VAZQUEZ
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Credential |
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Telephone | 787-293-0915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | PR
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