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General NPI Number Information
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NPI Number | 1710129911
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Entity Type | Organization
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Legal Business Name | SPIRIT OPTICAL INC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 3274 PASEO COLINA URB LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949-3123
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Country | US
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Telephone | 787-630-5030
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Fax | 787-946-0503
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Provider Business Mailing Address
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Address Line | 3274 PASEO COLINA URB LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949-3123
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Country | US
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Telephone | 787-630-5030
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Fax | 787-946-0503
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Authorized Official
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Title or Position | LICENCIADO OPTICO
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Name | MRS. MADELINE MELENDEZ
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Credential | LIC
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Telephone | 787-630-5030
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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 | 187395
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License Number State | PR
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