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General NPI Number Information
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NPI Number | 1891280194
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Entity Type | Organization
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Legal Business Name | OPTOMETRY PHYSICIAN SERVICES PSC
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 400 CALLE BETANCES
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City | CAGUAS
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State | PR
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Zip | 00725-5200
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Country | US
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Telephone | 787-746-0965
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 360949
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City | SAN JUAN
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State | PR
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Zip | 00936-0949
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Country | US
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Telephone | 787-312-9815
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Fax |
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Authorized Official
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Title or Position | PRESIDENTA
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Name | ELSIE NOEMI DE LA TEXERA
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Credential | OD
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Telephone | 787-312-9815
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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 | 512-024
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License Number State | PR
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