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General NPI Number Information
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NPI Number | 1750618922
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Entity Type | Organization
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Legal Business Name | ICONOS VISION
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | #610 AVE COMERIO CARR. 167
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City | TOA BAJA
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State | PR
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Zip | 00949-4067
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Country | US
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Telephone | 787-795-9292
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Fax | 787-795-9292
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Provider Business Mailing Address
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Address Line | #610 AVE COMERIO CARR. 167
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City | TOA BAJA
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State | PR
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Zip | 00949-4067
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Country | US
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Telephone | 787-795-9292
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Fax | 787-795-9292
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ISABEL OLMEDA
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Credential |
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Telephone | 787-795-9292
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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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