Provider Demographics
NPI:1912463175
Name:BOG GROUP CORP
Entity Type:Organization
Organization Name:BOG GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:SIMONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-1000
Mailing Address - Street 1:425 CALLE 693
Mailing Address - Street 2:PMB 218
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-796-1000
Mailing Address - Fax:787-796-0000
Practice Address - Street 1:CARR 693 KM 8.0
Practice Address - Street 2:DORADO DEL MAR SHOPPING CENTER
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-796-1000
Practice Address - Fax:787-796-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty