Provider Demographics
NPI:1821658949
Name:LENS OPTICAL BOUTIQUE CORP
Entity Type:Organization
Organization Name:LENS OPTICAL BOUTIQUE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICO
Authorized Official - Prefix:
Authorized Official - First Name:ZORY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:FELICIANO GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-270-1803
Mailing Address - Street 1:PO BOX 8730
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8730
Mailing Address - Country:US
Mailing Address - Phone:939-270-1803
Mailing Address - Fax:
Practice Address - Street 1:1234 PASEO LAS MONJITAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:939-270-1803
Practice Address - Fax:787-651-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier