Provider Demographics
NPI:1649720541
Name:E-OPTICAL
Entity type:Organization
Organization Name:E-OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-366-1007
Mailing Address - Street 1:751 CALLE 19
Mailing Address - Street 2:LAS PALMAS VILLAGE SUITE 3
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-6341
Mailing Address - Country:US
Mailing Address - Phone:787-720-6092
Mailing Address - Fax:787-720-6092
Practice Address - Street 1:751 CALLE 19
Practice Address - Street 2:LAS PALMAS VILLAGE SUITE 3
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-6341
Practice Address - Country:US
Practice Address - Phone:787-720-6092
Practice Address - Fax:787-720-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR852156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty