Provider Demographics
NPI:1962010876
Name:OPTICA SUR LLC
Entity Type:Organization
Organization Name:OPTICA SUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-944-9525
Mailing Address - Street 1:30 URB TERRA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-3245
Mailing Address - Country:US
Mailing Address - Phone:787-674-5070
Mailing Address - Fax:
Practice Address - Street 1:PORTOFINO PLAZA #2
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-944-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty