Provider Demographics
NPI:1225229313
Name:JOSE G MELENDEZ
Entity Type:Organization
Organization Name:JOSE G MELENDEZ
Other - Org Name:EAGLE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-849-2939
Mailing Address - Street 1:P O BOX 880
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00660
Mailing Address - Country:UM
Mailing Address - Phone:787-849-2936
Mailing Address - Fax:787-849-2936
Practice Address - Street 1:BO LAVADERO CARR 2 KM 167-4
Practice Address - Street 2:EDIFICIO MR SPECIAL
Practice Address - City:HORMIGUEROS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00660
Practice Address - Country:UM
Practice Address - Phone:787-849-2936
Practice Address - Fax:787-849-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR376156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty