MEDICARE: CUPEY OPTICAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	387	PR

General Provider Information

NPI Number	:	1033440664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUPEY OPTICAL INC.

Provider Business Mailing Address
First Line	:	SUITE 110 AVE SAN CLAUDIO 359
Second Line	:	CUPEY PROFESSIONAL MALL
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-748-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 CALLE SAN CLAUDIO # CUPEY
Second Line	:	SUITE 110 AVE SAN CLAUDIO 359
City	:	SAN JUAN
State	:	PR
Zip	:	00926-9907
Country	:	US
Telephone Number	:	787-748-8833
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS ANA EMIL GONZALEZ
Credential	:
Telephone Number	:	787-748-8833

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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Directions to “CUPEY OPTICAL INC. ” Practice Location

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