Provider Demographics
NPI:1891280194
Name:OPTOMETRY PHYSICIAN SERVICES PSC
Entity Type:Organization
Organization Name:OPTOMETRY PHYSICIAN SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:NOEMI
Authorized Official - Last Name:DE LA TEXERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-312-9815
Mailing Address - Street 1:PO BOX 360949
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0949
Mailing Address - Country:US
Mailing Address - Phone:787-312-9815
Mailing Address - Fax:
Practice Address - Street 1:400 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5200
Practice Address - Country:US
Practice Address - Phone:787-746-0965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR512-024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty