Provider Demographics
NPI:1033834932
Name:OPTIMA VISION 2 LLC
Entity Type:Organization
Organization Name:OPTIMA VISION 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-368-5905
Mailing Address - Street 1:URB. CIUDAD JARDIN
Mailing Address - Street 2:19 CALLE GLADIOLA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-368-5905
Mailing Address - Fax:
Practice Address - Street 1:AVE. 65 INANTERIA LOS COLOBOS SHOPPING CENTER
Practice Address - Street 2:CARR. #3 KM 14 LOCAL 15
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-368-5905
Practice Address - Fax:787-769-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty