Provider Demographics
NPI:1699356444
Name:HIRAM OPTICAL LLC
Entity Type:Organization
Organization Name:HIRAM OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMEDA-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-460-4255
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-460-4255
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE ANTONIO LOPEZ
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-460-4255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty