Provider Demographics
NPI:1114693496
Name:VM OPTICAL LLC
Entity Type:Organization
Organization Name:VM OPTICAL LLC
Other - Org Name:VG OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICO LICENCIADA
Authorized Official - Phone:939-777-2566
Mailing Address - Street 1:1000 MALL OF SAN JUAN BLVD STE 251
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4098
Mailing Address - Country:US
Mailing Address - Phone:939-777-0377
Mailing Address - Fax:
Practice Address - Street 1:SAN LORENZO SHOPPING CENTER
Practice Address - Street 2:SUITE 12B ST ROAD #183 KM 1.0 BARRIO HATO
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00924-0092
Practice Address - Country:US
Practice Address - Phone:939-777-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty