Provider Demographics
NPI:1922557578
Name:DESIGNER EYES
Entity Type:Organization
Organization Name:DESIGNER EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANCE MANAGER/ OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-246-1079
Mailing Address - Street 1:1000 MALL OF SAN JUAN BLVD
Mailing Address - Street 2:STORE 140
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4034
Mailing Address - Country:US
Mailing Address - Phone:787-490-0085
Mailing Address - Fax:
Practice Address - Street 1:1000 MALL OF SAN JUAN
Practice Address - Street 2:STORE 140
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-490-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier