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General NPI Number Information
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NPI Number | 1902870124
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Entity Type | Organization
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Legal Business Name | WESTERN OPTICAL SERVICES CSP
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Dates
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Enumeration Date | 02/14/2006
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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 CARBONELL #77
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City | CABO ROJO
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State | PR
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Zip | 00623
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Country | US
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Telephone | 787-851-5265
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Fax | 787-255-0760
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Provider Business Mailing Address
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Address Line | CALLE CARBONELL #77 BOX 1302
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City | CABO ROJO
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State | PR
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Zip | 00623
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Country | US
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Telephone | 787-851-5265
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Fax | 787-255-0760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLOS T GARCIA
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Credential | OD
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Telephone | 787-851-5265
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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 | 117
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License Number State | PR
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