Provider Demographics
NPI:1316210735
Name:VISION GALLERY INC
Entity Type:Organization
Organization Name:VISION GALLERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOUK
Authorized Official - Middle Name:M
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-725-1100
Mailing Address - Street 1:142 CALLE DEL PARQUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1965
Mailing Address - Country:US
Mailing Address - Phone:787-725-1100
Mailing Address - Fax:787-725-1200
Practice Address - Street 1:142 CALLE DEL PARQUE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1965
Practice Address - Country:US
Practice Address - Phone:787-725-1100
Practice Address - Fax:787-725-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1306801550OtherINDIVIDUAL NPI