Provider Demographics
NPI:1164140430
Name:OPTICAL SUPERCENTER ARECIBO CORP
Entity Type:Organization
Organization Name:OPTICAL SUPERCENTER ARECIBO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-827-8101
Mailing Address - Street 1:3241 AVE MILITAR
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4091
Mailing Address - Country:US
Mailing Address - Phone:787-830-9000
Mailing Address - Fax:
Practice Address - Street 1:3241 AVE MILITAR
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4091
Practice Address - Country:US
Practice Address - Phone:787-830-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier