Provider Demographics
NPI:1750136974
Name:J.M. OPTICAL LLC
Entity type:Organization
Organization Name:J.M. OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIRANDA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:787-269-3715
Mailing Address - Street 1:100 PASEO SAN PABLO STE 402
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7022
Mailing Address - Country:US
Mailing Address - Phone:787-784-1900
Mailing Address - Fax:
Practice Address - Street 1:100 PASEO SAN PABLO STE 402
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7022
Practice Address - Country:US
Practice Address - Phone:787-784-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier