Provider Demographics
NPI:1730316621
Name:IMAGEN OPTICA
Entity Type:Organization
Organization Name:IMAGEN OPTICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-741-4969
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:VIEQUES
Mailing Address - State:PR
Mailing Address - Zip Code:00765-0015
Mailing Address - Country:US
Mailing Address - Phone:787-741-4969
Mailing Address - Fax:
Practice Address - Street 1:112 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765-3042
Practice Address - Country:US
Practice Address - Phone:787-741-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR267156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty