Provider Demographics
NPI:1073987541
Name:LM CENTRO VISUAL OPTICA L.L.C.
Entity Type:Organization
Organization Name:LM CENTRO VISUAL OPTICA L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-373-5558
Mailing Address - Street 1:37 CARR 140
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2806
Mailing Address - Country:US
Mailing Address - Phone:787-623-8689
Mailing Address - Fax:787-623-8691
Practice Address - Street 1:37 CARR 140
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2806
Practice Address - Country:US
Practice Address - Phone:787-623-8689
Practice Address - Fax:787-623-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty