Provider Demographics
NPI:1518186345
Name:OPTICENTER LOIZA VALLEY
Entity Type:Organization
Organization Name:OPTICENTER LOIZA VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCIADO OPTICO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-876-0820
Mailing Address - Street 1:EDIFICIO AA10
Mailing Address - Street 2:LOIZAVALLEY MALL
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-876-0820
Mailing Address - Fax:787-876-0820
Practice Address - Street 1:AA10
Practice Address - Street 2:LOIZAVALLEY SHOPPING CENTER
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-0820
Practice Address - Fax:787-876-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR750305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service