Provider Demographics
NPI:1649989260
Name:PARAISO OPTICAL LLC
Entity type:Organization
Organization Name:PARAISO OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-635-0286
Mailing Address - Street 1:PO BOX 364708
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4708
Mailing Address - Country:US
Mailing Address - Phone:787-635-0286
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL EL MAESTRO PRIMER NIVEL
Practice Address - Street 2:CALLE SERGIO CUEVAS BUSTAMENTE 550
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-635-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier