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General NPI Number Information
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NPI Number | 1528937372
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Entity Type | Organization
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Legal Business Name | EYEMART PR LLC
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | CC36 CALLE CEIBAS
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City | BAYAMON
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State | PR
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Zip | 00961-3419
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Country | US
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Telephone | 787-798-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 64 AVE.CONDADO PLAZA DEL CONDADO APTO.904
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-674-7749
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | WILDA IVETTE SANTIAGO
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Credential | OD
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Telephone | 787-674-7749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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