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General NPI Number Information
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NPI Number | 1679052773
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Entity Type | Organization
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Legal Business Name | CONDADO OPTICAL, LLC
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 1452 AVE ASHFORD COND ADA LIGIA 1A
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-636-8232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1995
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City | GUAYNABO
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State | PR
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Zip | 00970-1995
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Country | US
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Telephone | 787-636-8232
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. NILSE M VILAR
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Credential | OD
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Telephone | 787-268-6099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 537
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License Number State | PR
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