| Doctor Name: | MR. ANGEL LUIS LAUREANO-VEGA |
| NPI Number: | 1104001700 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICENCED OPTICIAN |
| License Number: | 538 |
| Business Practice Address: | Carr. 678 Km. 0.5 Pampanos Vega Alta, PR - 00692 |
| Business Phone Number: | 9395791843 |
| Business Fax Number: | 7877965183 |
| Mailing Address: | Po Box 3040, VEGA ALTA |
| State: | PR |
| Postal Code: | 006923040 |
| Phone Number: | 9395791843 |
| Fax Number: | 7877965183 |
| NPI Enumeration Date: | 01/02/2008 |
| NPI Last Update Date: | 01/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 538 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |