Provider Demographics
NPI:1396143673
Name:OPTICA VISUAL CORNER
Entity type:Organization
Organization Name:OPTICA VISUAL CORNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-767-4200
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO STE. 25
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-767-4200
Mailing Address - Fax:787-767-4200
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO STE. 25
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-767-4200
Practice Address - Fax:787-767-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier