Provider Demographics
NPI:1851426936
Name:BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO, INC.
Entity Type:Organization
Organization Name:BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO, INC.
Other - Org Name:LIONS EYE BANK OF PUERTO RICO, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:787-273-0597
Mailing Address - Street 1:PO BOX 363311
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3311
Mailing Address - Country:US
Mailing Address - Phone:787-273-0597
Mailing Address - Fax:787-273-0974
Practice Address - Street 1:V3-22 AVE SAN ALFONSO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-273-0597
Practice Address - Fax:787-273-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7349291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1851426936OtherNPI