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General NPI Number Information
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NPI Number | 1881683019
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Entity Type | Organization
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Legal Business Name | MAYAGUEZ OPTICAL LAB
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CALLE PERAL #14 EDIFICIO LA PALMA OFICINA 1A
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City | MAYAGUEZ
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State | PR
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Zip | 00680-4913
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Country | US
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Telephone | 787-834-2492
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Fax | 787-265-2190
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Provider Business Mailing Address
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Address Line | CALLE PERAL #14 EDIFICIO LA PALMA OFICINA 1A
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City | MAYAGUEZ
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State | PR
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Zip | 00680-4913
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Country | US
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Telephone | 787-834-2492
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Fax | 787-265-2190
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Authorized Official
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Title or Position | PRESIDENTE
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Name | KENNETH L VAZQUEZ SR.
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Credential |
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Telephone | 787-834-2492
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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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