Provider Demographics
NPI:1720293954
Name:LC OPTICAL VISION CENTER
Entity Type:Organization
Organization Name:LC OPTICAL VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-839-2131
Mailing Address - Street 1:MANSIONES DEL CARIBE 55 CALLE JADE
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-380-6715
Mailing Address - Fax:787-839-2131
Practice Address - Street 1:CENTRO COOP MAUNA COOP
Practice Address - Street 2:CARR 3 INT. 178
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-839-2131
Practice Address - Fax:787-839-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMMMOther890162
PR7140015OtherHUMANA
PRPR0540OtherEYE MED VISION CARE
PR100030OtherLA CRUZ AZUL DE PR
PRTRIPLE SOther62541
PRPR0540OtherEYE MED VISION CARE
PR62541Medicare ID - Type Unspecified