Provider Demographics
NPI:1063003093
Name:UNIQUE OPTICAL INC
Entity Type:Organization
Organization Name:UNIQUE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-515-5858
Mailing Address - Street 1:REPARTO VALENCIA CALLE 9 AG4
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-462-5062
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL ROYAL GARDENS CARR 167 KM 18.7 LOCAL 8
Practice Address - Street 2:OPTIONAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-515-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIQUE OPTICAL INC BAYAMON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038349000Medicaid