Provider Demographics
NPI:1679876882
Name:NEW VISION MEDICAL DIAGNOSTIC OPTIC
Entity Type:Organization
Organization Name:NEW VISION MEDICAL DIAGNOSTIC OPTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-778-5353
Mailing Address - Street 1:BAYAMON MEDICAL MALL # J23
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7200
Mailing Address - Country:US
Mailing Address - Phone:787-778-5353
Mailing Address - Fax:787-778-5302
Practice Address - Street 1:BAYAMON MEDICAL MALL # J23
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-778-5353
Practice Address - Fax:787-778-5302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW VISION MEDICAL DIAGNOSTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty