Provider Demographics
NPI:1225306145
Name:OPTICA MENDEZ INC. DBA VISTAOPTIC
Entity Type:Organization
Organization Name:OPTICA MENDEZ INC. DBA VISTAOPTIC
Other - Org Name:VISTAOPTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-457-5727
Mailing Address - Street 1:PO BOX 367476
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7476
Mailing Address - Country:US
Mailing Address - Phone:787-457-5727
Mailing Address - Fax:
Practice Address - Street 1:28 CALLE SAN EDMUNDO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6437
Practice Address - Country:US
Practice Address - Phone:787-457-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR308156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty