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General NPI Number Information
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NPI Number | 1659647006
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Entity Type | Organization
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Legal Business Name | SAN LORENZO VISION CENTER
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | CALLE TOUS SOTO 150 ESQ. VALERIANO MUNOZ
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City | SAN LORENZO
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State | PR
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Zip | 00754
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Country | US
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Telephone | 787-736-2465
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Fax | 787-736-2465
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Provider Business Mailing Address
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Address Line | CALLE TOUS SOTO 150 ESQ. VALERIANO MUNOZ
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City | SAN LORENZO
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State | PR
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Zip | 00754
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Country | US
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Telephone | 787-736-2465
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Fax | 787-736-2465
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ANNETTE AILEEN MONTALVO
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Credential | O.D.
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Telephone | 787-736-2465
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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 | 546
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License Number State | PR
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