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General NPI Number Information
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NPI Number | 1669631305
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Entity Type | Organization
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Legal Business Name | CITY OPTICAL
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Dates
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Enumeration Date | 06/07/2008
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 12 CALLE ROBLES
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City | SAN JUAN
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State | PR
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Zip | 00925-2919
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Country | US
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Telephone | 787-766-9376
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Fax |
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Provider Business Mailing Address
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Address Line | 485 BAYAMON LA CUMBRE
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City | SAN JUAN
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State | PR
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Zip | 00926-2919
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARISOL RODRIGUEZ
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Credential | OPTOMETRIST
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Telephone | 787-766-9376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 397
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License Number State | PR
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