Provider Demographics
NPI:1588655427
Name:OPTICA Y LABORATORIO CENTRAL INC
Entity Type:Organization
Organization Name:OPTICA Y LABORATORIO CENTRAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO-NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-8655
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0557
Mailing Address - Country:US
Mailing Address - Phone:787-878-8655
Mailing Address - Fax:787-816-0317
Practice Address - Street 1:163 CALLE BARCELO
Practice Address - Street 2:CALLE ANTONIO R
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4560
Practice Address - Country:US
Practice Address - Phone:787-878-8655
Practice Address - Fax:787-816-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR050156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
O51893Medicare UPIN