Provider Demographics
NPI:1770825531
Name:PRO VISION OPTICAL INC
Entity Type:Organization
Organization Name:PRO VISION OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-854-9300
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-9300
Mailing Address - Fax:787-884-5240
Practice Address - Street 1:EDIFICIO MANUEL 'BUNDY' JIMENEZ AVE.
Practice Address - Street 2:VICTOR ROJAS SUITE #3
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-854-9300
Practice Address - Fax:787-854-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR420152W00000X
156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty