Provider Demographics
NPI:1225406309
Name:MASTER OPTICS DESING
Entity Type:Organization
Organization Name:MASTER OPTICS DESING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:GENARO
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC 1965974
Authorized Official - Phone:787-412-5865
Mailing Address - Street 1:PO BOX 1456
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1456
Mailing Address - Country:US
Mailing Address - Phone:787-412-5865
Mailing Address - Fax:787-933-3636
Practice Address - Street 1:CARR 2 MARGINAL KM 85.5
Practice Address - Street 2:BO CARRIZALES
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-412-5865
Practice Address - Fax:787-933-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1965794156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty