Provider Demographics
NPI:1487866166
Name:EYE EXPRESS 20-20
Entity Type:Organization
Organization Name:EYE EXPRESS 20-20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:GLADYS
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-876-5511
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0938
Mailing Address - Country:US
Mailing Address - Phone:787-876-5511
Mailing Address - Fax:
Practice Address - Street 1:EYE EXPRESS 20-20, PLAZA RIAL, HWY 185, KM .9
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-5511
Practice Address - Fax:787-876-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR167332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4104-5OtherPROSSAM
PR890103OtherMMM
PR890103OtherMMM
PR0777041OtherCRUZ AZUL
PR0777041OtherCRUZ AZUL
PR215278OtherPREFERRED
PR=========OtherMCS CLASSICARE