Provider Demographics
NPI:1760465066
Name:M&M OPTICAL SHOP CORP
Entity Type:Organization
Organization Name:M&M OPTICAL SHOP CORP
Other - Org Name:LA OPTICA ALTAMIRA VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-625-9144
Mailing Address - Street 1:PO BOX 7891 PMB 333
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:US
Mailing Address - Phone:787-782-2175
Mailing Address - Fax:787-782-2175
Practice Address - Street 1:1900 AVE J T PINERO
Practice Address - Street 2:ALTAMIRA XTRA SHOPPING CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1102
Practice Address - Country:US
Practice Address - Phone:787-782-2175
Practice Address - Fax:787-782-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty