Provider Demographics
NPI:1477199313
Name:OPTI-VISION CENTER
Entity type:Organization
Organization Name:OPTI-VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECNICA OFTALMICA
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRILARRY LUGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-899-1800
Mailing Address - Street 1:P.O. BOX 227
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-1800
Mailing Address - Fax:787-899-1800
Practice Address - Street 1:CALLE JOSE M TORO BASORA #4
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-1800
Practice Address - Fax:787-899-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty