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General NPI Number Information
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NPI Number | 1912463175
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Entity Type | Organization
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Legal Business Name | BOG GROUP CORP
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | CARR 693 KM 8.0 DORADO DEL MAR SHOPPING CENTER
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-796-1000
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Fax | 787-796-0000
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Provider Business Mailing Address
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Address Line | 425 CALLE 693 PMB 218
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-796-1000
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Fax | 787-796-0000
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Authorized Official
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Title or Position | MANAGER
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Name | ROBERTO FERNANDO SIMONI
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Credential |
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Telephone | 787-796-1000
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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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