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General NPI Number Information
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NPI Number | 1518258599
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Entity Type | Organization
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Legal Business Name | LOGUS INC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 200 BOULEVARD DR. VIDAL ST. SUITE 41
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-852-2125
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Fax | 787-852-2125
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Provider Business Mailing Address
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Address Line | EL COMANDANTE AVE. HN-20 COUNTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00982
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Country | US
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Telephone | 787-852-2125
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Fax | 787-852-2125
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | YAIMI ROMERO
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Credential | O.D.
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Telephone | 787-852-2125
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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 | 610
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License Number State | PR
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