Provider Demographics
NPI:1073652897
Name:EJ OPTICS PUERTO RICO, INC
Entity Type:Organization
Organization Name:EJ OPTICS PUERTO RICO, INC
Other - Org Name:MACY'S VISION EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-296-3922
Mailing Address - Street 1:525 ROOSEVELT AVE
Mailing Address - Street 2:PLAZA LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-8001
Mailing Address - Country:US
Mailing Address - Phone:787-296-3922
Mailing Address - Fax:787-296-3902
Practice Address - Street 1:525 ROOSEVELT AVE
Practice Address - Street 2:PLAZA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-296-3922
Practice Address - Fax:787-296-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR686156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty