Provider Demographics
NPI:1376636639
Name:DORADO VISUAL CENTER, INC.
Entity Type:Organization
Organization Name:DORADO VISUAL CENTER, INC.
Other - Org Name:OPTICA DORADO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-796-4155
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0670
Mailing Address - Country:US
Mailing Address - Phone:787-796-4155
Mailing Address - Fax:787-796-3746
Practice Address - Street 1:410 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 201
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4800
Practice Address - Country:US
Practice Address - Phone:787-796-4155
Practice Address - Fax:787-796-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6189332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97569Medicare ID - Type Unspecified