Provider Demographics
NPI:1972600534
Name:OLMEDA, HIRAM (OPTICO)
Entity Type:Individual
Prefix:
First Name:HIRAM
Middle Name:
Last Name:OLMEDA
Suffix:
Gender:M
Credentials:OPTICO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0001
Mailing Address - Country:US
Mailing Address - Phone:787-460-4255
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE ANTONIO LOPEZ
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4224
Practice Address - Country:US
Practice Address - Phone:787-460-4255
Practice Address - Fax:787-285-1250
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
PR488156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier