Provider Demographics
NPI:1558008995
Name:L'OTTICA,INC
Entity Type:Organization
Organization Name:L'OTTICA,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-307-3546
Mailing Address - Street 1:100 CALLE FONT MARTELO W STE 320
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3970
Mailing Address - Country:US
Mailing Address - Phone:787-307-3546
Mailing Address - Fax:
Practice Address - Street 1:AVE FRAGOSA ESQ. CALLE FIDALGO
Practice Address - Street 2:LOCAL 15 PLAZA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-934-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1386750743Medicaid