Provider Demographics
NPI:1629266606
Name:PONCE VISION EXPRESS
Entity Type:Organization
Organization Name:PONCE VISION EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-872-2977
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1429
Mailing Address - Country:US
Mailing Address - Phone:787-872-2977
Mailing Address - Fax:787-830-3216
Practice Address - Street 1:AVENIDA JUAN HERNANDEZ
Practice Address - Street 2:CENTRO COMERCIAL COOP#1
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-2977
Practice Address - Fax:787-830-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051831OtherCRUZ AZUL
PR054595OtherTRIPLES
PR583308262OtherMAPFRE
PR583308262OtherMAPFRE