Provider Demographics
NPI:1811621659
Name:PRO VISION OPTICAL LLC
Entity Type:Organization
Organization Name:PRO VISION OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENDEZ LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
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:00674-0851
Mailing Address - Country:US
Mailing Address - Phone:787-854-9300
Mailing Address - Fax:787-854-6639
Practice Address - Street 1:PLAZA GATSBY
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-854-9300
Practice Address - Fax:787-854-6639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRO VISION OPTICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty