=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619961406
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE LUIS KEY OYOLA OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #3 DEGETAU AIBONITO PR AIBONITO OPTICAL
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-735-0043
-----------------------------------------------------
Fax | 787-735-0043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 CALLE APENINOS
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00920-4127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-342-3555
-----------------------------------------------------
Fax | 787-735-0043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 387
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------