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General NPI Number Information
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NPI Number | 1912653122
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Entity Type | Organization
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Legal Business Name | OPTICA PRISMA
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | PR 402 KM 2.9 BARRIO QUEBRADA LARGA VALLEY HILLS PROFESSIONAL CENTER SUITE 11
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City | ANASCO
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State | PR
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Zip | 00610
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Country | US
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Telephone | 787-918-1749
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Fax |
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Provider Business Mailing Address
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Address Line | 205 OESTE CALLE DE LA CANDELARIA
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City | MAYAGUEZ
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State | PR
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Zip | 00682
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Country | US
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Telephone | 787-918-1749
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARINA MICHELLE MERCADO
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Credential | OD
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Telephone | 787-918-1749
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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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