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General NPI Number Information
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NPI Number | 1972653673
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Entity Type | Organization
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Legal Business Name | OHI OF PUERTO RICO, LLC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | REXVILLE TOWN CTR BLDG A4 RD #167 K.M. 17.6
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City | BAYAMON
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State | PR
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Zip | 00956-9212
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Country | US
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Telephone | 787-279-8137
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Fax |
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Provider Business Mailing Address
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Address Line | 275 ROUTE 22
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-3554
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Country | US
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Telephone | 917-716-7666
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Fax |
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Authorized Official
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Title or Position | DIRECTOR; ASSIGNMENT OPERATIONS
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Name | MR. ISAIAS CALDERON
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Credential |
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Telephone | 787-925-1851
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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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