Provider Demographics
NPI:1144423377
Name:OPTICA RIO PIEDRAS
Entity Type:Organization
Organization Name:OPTICA RIO PIEDRAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANISSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-754-7323
Mailing Address - Street 1:1072 CALLE WILLIAM JONES
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3831
Mailing Address - Country:US
Mailing Address - Phone:787-754-7323
Mailing Address - Fax:787-274-8725
Practice Address - Street 1:1072 CALLE WILLIAM JONES
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3831
Practice Address - Country:US
Practice Address - Phone:787-754-7323
Practice Address - Fax:787-274-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20466Medicare ID - Type Unspecified
PRU91200Medicare UPIN