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General NPI Number Information
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NPI Number | 1811621659
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Entity Type | Organization
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Legal Business Name | PRO VISION OPTICAL LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | PLAZA GATSBY
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-854-9300
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Fax | 787-854-6639
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Provider Business Mailing Address
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Address Line | PO BOX 851
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City | MANATI
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State | PR
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Zip | 00674-0851
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Country | US
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Telephone | 787-854-9300
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Fax | 787-854-6639
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILSON J. MENDEZ LUGO
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Credential |
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Telephone | 787-854-9300
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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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Taxonomy #2
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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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