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General NPI Number Information
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NPI Number | 1760672083
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Entity Type | Organization
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Legal Business Name | OPTICA DEL SUR
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 1485 BLVD MIGUEL POW #207 CENTRO DEL SUR MALL
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City | PONCE
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State | PR
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Zip | 00717-2719
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Country | US
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Telephone | 787-844-0385
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Fax | 787-844-0385
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Provider Business Mailing Address
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Address Line | 1485 BLVD MIGUEL POW #207 CENTRO DEL SUR MALL
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City | PONCE
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State | PR
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Zip | 00717-2719
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Country | US
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Telephone | 787-844-0385
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Fax | 787-844-0385
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOSE A MATTEI SR.
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Credential | OD
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Telephone | 787-844-0385
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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 | 190
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License Number State | PR
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