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General NPI Number Information
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NPI Number | 1972719243
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Entity Type | Organization
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Legal Business Name | EYE CARE OPTICAL EXPRESS
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | #36 GAUTIER BENITEZ SUITE 101
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-744-6021
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Fax | 787-744-6022
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Provider Business Mailing Address
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Address Line | PISO 1 G-14 PLAZA GAUTIER
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone | 787-744-6021
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Fax | 787-744-6022
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ILIAN Y DIAZ
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Credential | O.D.
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Telephone | 787-744-6021
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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 | 543
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License Number State | PR
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