Provider Demographics
NPI:1689133894
Name:BORINQUEN VISION CORP.
Entity Type:Organization
Organization Name:BORINQUEN VISION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-909-2549
Mailing Address - Street 1:URB. ORIENTE # 65, ST. LUIS PALES
Mailing Address - Street 2:MATOS
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-909-2549
Mailing Address - Fax:
Practice Address - Street 1:410 AVE MONTE SOL STE 9
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-5102
Practice Address - Country:US
Practice Address - Phone:787-860-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty