Provider Demographics
NPI:1598454506
Name:YOUR VISION OPTICAL
Entity Type:Organization
Organization Name:YOUR VISION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIBELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:787-405-6795
Mailing Address - Street 1:URB. VILLA LOS SANTOS C/18 BB 8
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-405-6795
Mailing Address - Fax:
Practice Address - Street 1:73 CALLE DR CUETO
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2804
Practice Address - Country:US
Practice Address - Phone:787-405-6795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty