Provider Demographics
NPI:1659647006
Name:SAN LORENZO VISION CENTER
Entity Type:Organization
Organization Name:SAN LORENZO VISION CENTER
Other - Org Name:ANNETTE A MONTALVO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-736-2465
Mailing Address - Street 1:CALLE TOUS SOTO 150 ESQ. VALERIANO MUNOZ
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-736-2465
Mailing Address - Fax:787-736-2465
Practice Address - Street 1:CALLE TOUS SOTO 150 ESQ. VALERIANO MUNOZ
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-2465
Practice Address - Fax:787-736-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR546332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier