Provider Demographics
NPI:1174275150
Name:O G BLESS VISION LLC
Entity Type:Organization
Organization Name:O G BLESS VISION LLC
Other - Org Name:NOVA OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICO LICENCIADO
Authorized Official - Phone:787-612-9301
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO CANAS CARR 10 KM 0.1
Practice Address - Street 2:LOCAL 9 SHOPPING ECONO MOREL CAMPOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty