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General NPI Number Information
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NPI Number | 1881874857
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Entity Type | Organization
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Legal Business Name | LEVITTOWN OPTICAL INC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | #9 DR ALVAREZ CHANCA AVE LOCAL A 5TA SECC LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-690-8093
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Fax | 787-690-8926
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Provider Business Mailing Address
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Address Line | PB-4 CARIBE ST PARQUE PUNTA SALINAS
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-690-8093
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Fax | 787-690-8926
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MRS. SARAHI PRIETO MATTA
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Credential | LICENSED OPTICIAN
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Telephone | 787-662-1572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 621
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License Number State | PR
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