Provider Demographics
NPI:1831626316
Name:CENTURY OPTICAL
Entity type:Organization
Organization Name:CENTURY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-832-2945
Mailing Address - Street 1:DE DIEGO # 66 ESTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-9998
Mailing Address - Country:US
Mailing Address - Phone:787-832-2945
Mailing Address - Fax:787-831-3510
Practice Address - Street 1:66 DE DIEGO ESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-9998
Practice Address - Country:US
Practice Address - Phone:787-832-2945
Practice Address - Fax:787-831-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRLIC. 439332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier