Provider Demographics
NPI:1205504925
Name:AECV.LLC
Entity type:Organization
Organization Name:AECV.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-390-6337
Mailing Address - Street 1:232 CALLE ROBLE
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9034
Mailing Address - Country:US
Mailing Address - Phone:787-390-6337
Mailing Address - Fax:
Practice Address - Street 1:232 CALLE ROBLE
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9034
Practice Address - Country:US
Practice Address - Phone:787-390-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR681OtherSTATE LICENSE
PR1922301977OtherNPI
PRIC498ZOtherMEDICARE