Provider Demographics
NPI:1265046643
Name:INNOVA OPTICA DOS
Entity type:Organization
Organization Name:INNOVA OPTICA DOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLON RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-535-0315
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2058
Mailing Address - Country:US
Mailing Address - Phone:787-535-0315
Mailing Address - Fax:
Practice Address - Street 1:CARR 1 KM 56.7
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-535-0315
Practice Address - Fax:787-535-0316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE OPTICAL SERVICES AND MANAGEMENT GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-03
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty