MEDICARE: LK OPTICS 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1417673419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LK OPTICS LLC

Provider Business Mailing Address
First Line	:	LOS EUCALIPTOS 17015
Second Line	:	PRICE DRIVE
City	:	CANOVANAS
State	:	PR
Zip	:	00729
Country	:	US
Telephone Number	:	787-400-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1573 AVENIDA JESUS T. PINERO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920
Country	:	US
Telephone Number	:	787-400-0555
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIARA E VELILLA
Credential	:
Telephone Number	:	787-400-0555

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	10/12/2022

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