Provider Demographics
NPI:1497811491
Name:VISUAL GALLERY P.S.C.
Entity Type:Organization
Organization Name:VISUAL GALLERY P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-868-2181
Mailing Address - Street 1:HC 56 BOX 35640
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9787
Mailing Address - Country:US
Mailing Address - Phone:787-868-2181
Mailing Address - Fax:787-868-2181
Practice Address - Street 1:AVE. NATIVO ALERS
Practice Address - Street 2:EDIFICIO FARMACIA SAN ANTONIO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-2181
Practice Address - Fax:787-868-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty