Provider Demographics
NPI:1316415300
Name:THE OPTICS SHOP
Entity Type:Organization
Organization Name:THE OPTICS SHOP
Other - Org Name:THE OPTICS SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-960-2525
Mailing Address - Street 1:101 CALLE 2
Mailing Address - Street 2:BO PALENQUE
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-960-2525
Mailing Address - Fax:787-822-5050
Practice Address - Street 1:101 CALLE 2
Practice Address - Street 2:BO PALENQUE
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-960-2525
Practice Address - Fax:787-822-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier