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General NPI Number Information
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NPI Number | 1699366955
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Entity Type | Organization
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Legal Business Name | COROZAL OPTICAL
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | CARR 159 KM 13.1 LOCAL 5 SALIDA COROZAL A MOROVIS BLDG 5
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City | COROZAL
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State | PR
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Zip | 00783-0078
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Country | US
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Telephone | 787-689-7856
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Fax |
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Provider Business Mailing Address
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Address Line | CARR 159 KM 13.1 LOCAL 5 SALIDA COROZAL A MOROVIS BLDG 5
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City | COROZAL
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State | PR
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Zip | 00783-2903
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Country | US
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Telephone | 787-689-7856
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Fax |
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Authorized Official
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Title or Position | OPTICO
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Name | MR. JESUS M RIVERA
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Credential |
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Telephone | 787-689-7856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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