Provider Demographics
NPI:1083879787
Name:SAFETY LENS & EYE WEAR
Entity Type:Organization
Organization Name:SAFETY LENS & EYE WEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-736-2465
Mailing Address - Street 1:PLAZA BUXO # 3 MUNOZ RIVERA 216
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-4216
Mailing Address - Country:US
Mailing Address - Phone:787-736-2465
Mailing Address - Fax:787-736-2465
Practice Address - Street 1:216 CALLE MUNOZ RIVERA S
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4215
Practice Address - Country:US
Practice Address - Phone:787-736-2465
Practice Address - Fax:787-736-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152W00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty