Provider Demographics
NPI:1881231546
Name:LE PETIT VISION CENTER LLC
Entity Type:Organization
Organization Name:LE PETIT VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-504-1302
Mailing Address - Street 1:PO BOX 9192
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9192
Mailing Address - Country:US
Mailing Address - Phone:787-744-2821
Mailing Address - Fax:787-957-8680
Practice Address - Street 1:CONSOLIDATED MALL C-22, AVE GAUTIER BENITEZ 202
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9998
Practice Address - Country:US
Practice Address - Phone:787-744-2821
Practice Address - Fax:787-957-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center