MEDICARE: EYE CLASSY LLC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1245003441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CLASSY LLC

Provider Business Mailing Address
First Line	:	1699 CALLE PARANA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3143
Country	:	US
Telephone Number	:	787-553-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1699 CALLE PARANA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3143
Country	:	US
Telephone Number	:	787-553-8850
Fax Number	:	787-751-2493

Authorized Official
Title or Position	:	OPTICIAN, PRESIDENT
Name	:	PATRICIA NEVAREZ DE JESUS
Credential	:
Telephone Number	:	787-553-8850

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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