Provider Demographics
NPI:1578134904
Name:EYEVISION GALLERY LLC
Entity Type:Organization
Organization Name:EYEVISION GALLERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAMALISH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:939-383-8183
Mailing Address - Street 1:208 PARQUE TERRALINDA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-4061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 AVE ESMERALDA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4430
Practice Address - Country:US
Practice Address - Phone:939-383-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty