Provider Demographics
NPI:1942919386
Name:ECB DMALL LLC
Entity Type:Organization
Organization Name:ECB DMALL LLC
Other - Org Name:EYE CENTER BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMBRANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-672-4833
Mailing Address - Street 1:385 CALLE SAN CLAUDIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4251
Mailing Address - Country:US
Mailing Address - Phone:787-672-4833
Mailing Address - Fax:
Practice Address - Street 1:8888 SW 136TH ST STE 140
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5870
Practice Address - Country:US
Practice Address - Phone:787-672-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty