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General NPI Number Information
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NPI Number | 1972600534
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Entity Type | Individual
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Provider Name | HIRAM OLMEDA OPTICO
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Gender | Male
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 14 CALLE ANTONIO LOPEZ
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City | HUMACAO
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State | PR
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Zip | 00791-4224
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Country | US
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Telephone | 787-460-4255
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Fax | 787-285-1250
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Provider Business Mailing Address
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Address Line | PO BOX 1
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City | HUMACAO
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State | PR
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Zip | 00792-0001
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Country | US
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Telephone | 787-460-4255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 488
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License Number State | PR
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