Provider Demographics
NPI:1407556335
Name:DESIGNER EYES OF SAN JUAN, INC.
Entity Type:Organization
Organization Name:DESIGNER EYES OF SAN JUAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACKY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-915-1474
Mailing Address - Street 1:530 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6210
Mailing Address - Country:US
Mailing Address - Phone:954-915-1474
Mailing Address - Fax:954-915-1480
Practice Address - Street 1:1000 MALL OF SAN JUAN BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4071
Practice Address - Country:US
Practice Address - Phone:787-490-0085
Practice Address - Fax:954-914-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty