Provider Demographics
NPI:1710400015
Name:OPTICA DUARTE
Entity Type:Organization
Organization Name:OPTICA DUARTE
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NARVAEZ SOSTRE
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-772-4710
Mailing Address - Street 1:CALLE PARIS 243 PMB 1737
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-444-2226
Mailing Address - Fax:939-204-4367
Practice Address - Street 1:231 CALLE DUARTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3631
Practice Address - Country:US
Practice Address - Phone:787-772-4710
Practice Address - Fax:939-204-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty