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General NPI Number Information
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NPI Number | 1689310039
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Entity Type | Organization
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Legal Business Name | LOOKOPTICALOUTLET
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | AVE. DEGUETAU AA-5
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone | 939-338-3030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1600
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City | CIDRA
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State | PR
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Zip | 00739-1600
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Country | US
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Telephone | 939-338-3030
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Fax |
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Authorized Official
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Title or Position | DUENO
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Name | JOSE ANGEL GRILLO
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Credential |
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Telephone | 939-338-3030
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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 |
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License Number State |
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