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General NPI Number Information
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NPI Number | 1538461264
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Entity Type | Organization
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Legal Business Name | WCM VISUAL CARE PSC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 10 CALLE AQUAMARINA VILLA BLANCA
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City | CAGUAS
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State | PR
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Zip | 00725-1957
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Country | US
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Telephone | 787-258-5394
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Fax | 877-883-4503
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Provider Business Mailing Address
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Address Line | 10 CALLE AQUAMARINA VILLA BLANCA
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City | CAGUAS
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State | PR
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Zip | 00725-1957
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Country | US
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Telephone | 787-258-5394
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Fax | 877-883-4503
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILFREDO CRUZ-MARTINEZ
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Credential | O.D.
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Telephone | 787-258-5394
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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 | 440-0139
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License Number State | PR
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