Provider Demographics
NPI:1962042150
Name:RIVERA, GLORIMAR (SINGLE VISION & MORE)
Entity Type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:SINGLE VISION & MORE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 48 I#3 ROYAL TOWN
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-905-3584
Mailing Address - Fax:
Practice Address - Street 1:CALLE 48 I#3 ROYAL TOWN
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-905-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier