Provider Demographics
NPI:1639222979
Name:OHI OF PUERTO RICO, LLC
Entity Type:Organization
Organization Name:OHI OF PUERTO RICO, LLC
Other - Org Name:PEARLE VISION #C7214
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRISGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-580-7404
Mailing Address - Street 1:275 ROUTE 22
Mailing Address - Street 2:ATTN MEDICARE DEPT
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3554
Mailing Address - Country:US
Mailing Address - Phone:847-309-0098
Mailing Address - Fax:
Practice Address - Street 1:40 CARR #2 STE 80
Practice Address - Street 2:PLAZA ATENAS S/C
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier