=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568395150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CENTER BOUTIQUE - RIO HONDO MALL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 AVE RIO HONDO SUITE B071 RIO HONDO MALL
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-261-0981
-----------------------------------------------------
Fax | 239-231-2948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32010 CALLE LIVISTONIA # A-16
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-8302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-261-0981
-----------------------------------------------------
Fax | 239-231-2948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OMAR E ALVAREZ CORREA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-261-0981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------