Provider Demographics
NPI:1093012445
Name:OPTICA COLLADO, INC.
Entity Type:Organization
Organization Name:OPTICA COLLADO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-805-0795
Mailing Address - Street 1:16 CALLE NELSON PEREA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4948
Mailing Address - Country:US
Mailing Address - Phone:787-805-0795
Mailing Address - Fax:787-832-2533
Practice Address - Street 1:16 CALLE NELSON PEREA
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4948
Practice Address - Country:US
Practice Address - Phone:787-805-0795
Practice Address - Fax:787-832-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier