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General NPI Number Information
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NPI Number | 1699063891
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Entity Type | Organization
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Legal Business Name | OPTILOOK
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | MAHI MAHI SHOP CTR CARR 693 #4211 STE 20
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City | DORADO
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State | PR
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Zip | 00646-4804
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Country | US
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Telephone | 787-278-5932
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Fax | 787-278-5912
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Provider Business Mailing Address
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Address Line | MAHI MAHI SHOP CTR CARR 693 #4211 STE 20
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City | DORADO
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State | PR
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Zip | 00646-4804
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Country | US
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Telephone | 787-278-5932
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Fax | 787-278-5912
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DORIS M ANTUNEZ
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Credential | O.D.
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Telephone | 787-278-5932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 126
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License Number State | PR
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