Provider Demographics
NPI:1043607583
Name:OPTI-FACTORY
Entity Type:Organization
Organization Name:OPTI-FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-754-8615
Mailing Address - Street 1:500 AVE MUNOZ RIVERA
Mailing Address - Street 2:EL CENTRO 2 LOCAL 32
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3300
Mailing Address - Country:US
Mailing Address - Phone:787-754-8615
Mailing Address - Fax:787-754-8615
Practice Address - Street 1:500 AVE MUNOZ RIVERA
Practice Address - Street 2:EL CENTRO 2 LOCAL 32
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3300
Practice Address - Country:US
Practice Address - Phone:787-754-8615
Practice Address - Fax:787-754-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR515261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service