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General NPI Number Information
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NPI Number | 1699638700
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Entity Type | Organization
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Legal Business Name | EYE OPTICAL BOUTIQUE LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | URB. SIERRA BAYAMON 51-27 CALLE 49
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City | BAYAMON
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State | PR
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Zip | 00961-4422
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Country | US
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Telephone | 787-922-5883
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Fax | 877-408-9167
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Provider Business Mailing Address
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Address Line | 370 CALLE LUQUILLO
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-922-5883
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Fax | 877-408-9167
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. CHRISTIAN O MARRERO
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Credential | OD
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Telephone | 787-922-5883
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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