Provider Demographics
NPI:1104001700
Name:LAUREANO-VEGA, ANGEL LUIS (LICENCED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LUIS
Last Name:LAUREANO-VEGA
Suffix:
Gender:M
Credentials:LICENCED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3040
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3040
Mailing Address - Country:US
Mailing Address - Phone:939-579-1843
Mailing Address - Fax:787-796-5183
Practice Address - Street 1:CARR. 678 KM. 0.5
Practice Address - Street 2:PAMPANOS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:939-579-1843
Practice Address - Fax:787-796-5183
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR538156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician