Provider Demographics
NPI:1477949154
Name:I LOOK OPTICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:I LOOK OPTICAL MANAGEMENT, LLC
Other - Org Name:I LOOK OPTICA Y CLINICA VISUAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORAIMA
Authorized Official - Middle Name:DE LOURDES
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-505-1184
Mailing Address - Street 1:PO BOX 192173
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2173
Mailing Address - Country:US
Mailing Address - Phone:787-765-0039
Mailing Address - Fax:787-765-0039
Practice Address - Street 1:60 CALLE GEORGETTI
Practice Address - Street 2:SUITE 1A
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3607
Practice Address - Country:US
Practice Address - Phone:787-765-0039
Practice Address - Fax:787-765-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR588261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service