Provider Demographics
NPI:1255156642
Name:ENFOQUE OPTICO LLC
Entity type:Organization
Organization Name:ENFOQUE OPTICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURGOS ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-420-6139
Mailing Address - Street 1:HC 2 BOX 9956
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-9654
Mailing Address - Country:US
Mailing Address - Phone:787-420-6139
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE DEGETAU S # 103
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3637
Practice Address - Country:US
Practice Address - Phone:787-420-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier