Provider Demographics
NPI:1629257910
Name:OPTICA SAN VICENTE INC
Entity Type:Organization
Organization Name:OPTICA SAN VICENTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-844-8175
Mailing Address - Street 1:44 CALLE MAYOR
Mailing Address - Street 2:ZAMORA BUILDING FIRST FLOOR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3728
Mailing Address - Country:US
Mailing Address - Phone:787-844-8175
Mailing Address - Fax:787-259-4462
Practice Address - Street 1:44 CALLE MAYOR
Practice Address - Street 2:ZAMORA BUILDING FIRST FLOOR
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3728
Practice Address - Country:US
Practice Address - Phone:787-844-8175
Practice Address - Fax:787-259-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR135261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service