Provider Demographics
NPI:1447556337
Name:MFE VISION
Entity Type:Organization
Organization Name:MFE VISION
Other - Org Name:EYE CENTER BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-360-3006
Mailing Address - Street 1:2Q6 CALLE 17
Mailing Address - Street 2:MIRADOR BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1006
Mailing Address - Country:US
Mailing Address - Phone:787-703-4411
Mailing Address - Fax:787-703-4411
Practice Address - Street 1:400 CALLE BETANCES
Practice Address - Street 2:SUITE 480 LAS CATALINAS MALL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5059
Practice Address - Country:US
Practice Address - Phone:787-703-4411
Practice Address - Fax:787-703-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR343156FX1800X
261Q00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear Supplier