MEDICARE: GLASSES OPTICAL INCORPORADO

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
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1043855919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLASSES OPTICAL INCORPORADO

Provider Business Mailing Address
First Line	:	2939 AVE EMILIO FAGOT STE 2
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-3613
Country	:	US
Telephone Number	:	787-842-7033
Fax Number	:

Provider Business Practice Location Address
First Line	:	2939 AVE EMILIO FAGOT STE 2
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-3613
Country	:	US
Telephone Number	:	787-842-7033
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILFREDO GAUDINO
Credential	:	LICENSED OPTICIAN
Telephone Number	:	787-420-0783

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	08/25/2025

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Directions to “GLASSES OPTICAL INCORPORADO ” Practice Location

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