MEDICARE: EYE CENTER BOUTIQUE - RIO HONDO MALL

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1568395150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CENTER BOUTIQUE - RIO HONDO MALL

Provider Business Mailing Address
First Line	:	32010 CALLE LIVISTONIA # A-16
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-8302
Country	:	US
Telephone Number	:	787-261-0981
Fax Number	:	239-231-2948

Provider Business Practice Location Address
First Line	:	60 AVE RIO HONDO SUITE B071
Second Line	:	RIO HONDO MALL
City	:	BAYAMON
State	:	PR
Zip	:	00961-3106
Country	:	US
Telephone Number	:	787-261-0981
Fax Number	:	239-231-2948

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OMAR E ALVAREZ CORREA
Credential	:
Telephone Number	:	787-261-0981

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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