Provider Demographics
NPI:1659483006
Name:MIA SERVICIOS OPTOMTRICOS
Entity Type:Organization
Organization Name:MIA SERVICIOS OPTOMTRICOS
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARDONA-SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-870-2339
Mailing Address - Street 1:PEARLE VISION CENTER, ROAD # 165
Mailing Address - Street 2:PLAZA AQUARIUM MALL, SUITE #6
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-870-2339
Mailing Address - Fax:787-870-2339
Practice Address - Street 1:PEARLE VISION CENTER, ROAD # 165
Practice Address - Street 2:PLAZA AQUARIUM MALL, SUITE #6
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-2339
Practice Address - Fax:787-870-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN