Provider Demographics
NPI:1801529714
Name:OPTICA REAL LLC
Entity type:Organization
Organization Name:OPTICA REAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERENTE
Authorized Official - Prefix:
Authorized Official - First Name:MARIANELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-430-5899
Mailing Address - Street 1:URB SAN FERNANDO CALLE 15 C3
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-920-2080
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MAVILLAS CARR 159 KM 16.7 #A3
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-920-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier