Provider Demographics
NPI:1598982365
Name:DR JOSE N LUGO DBA OPTOMETRY WORLD CAROLINA
Entity Type:Organization
Organization Name:DR JOSE N LUGO DBA OPTOMETRY WORLD CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-750-6705
Mailing Address - Street 1:10000 AVE 65 INFANTERIA STE 112
Mailing Address - Street 2:CAROLINA SHOPPING COURT
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5638
Mailing Address - Country:US
Mailing Address - Phone:787-750-6705
Mailing Address - Fax:787-762-3212
Practice Address - Street 1:10000 AVE 65 INFANTERIA STE 112
Practice Address - Street 2:CAROLINA SHOPPING COURT
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5638
Practice Address - Country:US
Practice Address - Phone:787-750-6705
Practice Address - Fax:787-762-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU31587Medicare UPIN
PR58095Medicare ID - Type Unspecified