Provider Demographics
NPI: | 1245576099 |
---|---|
Name: | BE PROFESSIONAL,PSC |
Entity Type: | Organization |
Organization Name: | BE PROFESSIONAL,PSC |
Other - Org Name: | ATLANTIS OPTICAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BAEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 939-246-1079 |
Mailing Address - Street 1: | PO BOX 6029 |
Mailing Address - Street 2: | PMB 2296 |
Mailing Address - City: | CAROLINA |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00984-6029 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 939-246-1079 |
Mailing Address - Fax: | 186-689-9305 |
Practice Address - Street 1: | AVE MONSERRATE # 97 |
Practice Address - Street 2: | NUMERO 28 VILLA CAROLINA |
Practice Address - City: | CAROLINA |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00985-5444 |
Practice Address - Country: | US |
Practice Address - Phone: | 939-246-1079 |
Practice Address - Fax: | 186-689-9305 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-12-26 |
Last Update Date: | 2012-12-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
152W00000X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 156FC0800X, 156FC0801X, 156FX1201X, 156FX1202X, 174H00000X, 332900000X, 332H00000X | ||
PR | 480 | 156FX1800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 152WL0500X | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | Group - Multi-Specialty |
No | 152WP0200X | Eye and Vision Services Providers | Optometrist | Pediatrics | Group - Multi-Specialty |
No | 152WS0006X | Eye and Vision Services Providers | Optometrist | Sports Vision | Group - Multi-Specialty |
No | 152WV0400X | Eye and Vision Services Providers | Optometrist | Vision Therapy | Group - Multi-Specialty |
No | 152WX0102X | Eye and Vision Services Providers | Optometrist | Occupational Vision | Group - Multi-Specialty |
No | 156FC0800X | Eye and Vision Services Providers | Technician/Technologist | Contact Lens | Group - Multi-Specialty |
No | 156FC0801X | Eye and Vision Services Providers | Technician/Technologist | Contact Lens Fitter | Group - Multi-Specialty |
No | 156FX1201X | Eye and Vision Services Providers | Technician/Technologist | Optometric Assistant | Group - Multi-Specialty |
No | 156FX1202X | Eye and Vision Services Providers | Technician/Technologist | Optometric Technician | Group - Multi-Specialty |
No | 156FX1800X | Eye and Vision Services Providers | Technician/Technologist | Optician | Group - Multi-Specialty |
No | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site | ||
No | 332H00000X | Suppliers | Eyewear Supplier | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PR | 312449 | Other | CORPORATE ID NUMBER |