Organization Name: | OPTICA ALTA VISION |
NPI Number: | 1154596633 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARILLIAM JORGE (OWNER) |
Mailing Address: | Carr. 829 Km 2.7 Bo. Pinas Toa Alta |
State: | PR US |
Postal Code: | 00953 |
Phone Number: | 7877976978 |
Fax Number: | |
NPI Enumeration Date: | 04/25/2008 |
NPI Last Update Date: | 05/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |