Provider Demographics
NPI:1245400480
Name:VIOLETA COLLAZO IRIZARRY
Entity Type:Organization
Organization Name:VIOLETA COLLAZO IRIZARRY
Other - Org Name:OPTICA LABORATORIO DEL SUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-6808
Mailing Address - Street 1:PO BOX 10369
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0369
Mailing Address - Country:US
Mailing Address - Phone:787-841-6808
Mailing Address - Fax:787-841-6808
Practice Address - Street 1:AVE LAS AMERICAS 2431 EDIF A PORRATA PILA SUITE 200
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-841-6808
Practice Address - Fax:787-841-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR066332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0441010001Medicare NSC