Provider Demographics
NPI:1497387492
Name:OPTICA A DOMICILIO
Entity Type:Organization
Organization Name:OPTICA A DOMICILIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICO LIC
Authorized Official - Prefix:
Authorized Official - First Name:YOMAIRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-309-5569
Mailing Address - Street 1:ISLOTE 2 CALLE 11
Mailing Address - Street 2:CASA 242
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-309-5569
Mailing Address - Fax:
Practice Address - Street 1:CALLE TOMAS DAVILA 1
Practice Address - Street 2:TMG MEFICAL
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-0061
Practice Address - Country:US
Practice Address - Phone:787-309-5569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty