Provider Demographics
NPI:1538288816
Name:WS OPTICA CENTRO CSP
Entity Type:Organization
Organization Name:WS OPTICA CENTRO CSP
Other - Org Name:OPTICA CENTRO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-258-5394
Mailing Address - Street 1:10 CALLE AQUAMARINA
Mailing Address - Street 2:VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1957
Mailing Address - Country:US
Mailing Address - Phone:787-258-5394
Mailing Address - Fax:787-653-3290
Practice Address - Street 1:10 CALLE AQUAMARINA
Practice Address - Street 2:VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1957
Practice Address - Country:US
Practice Address - Phone:787-258-5394
Practice Address - Fax:787-653-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty