Provider Demographics
NPI:1912653122
Name:OPTICA PRISMA
Entity Type:Organization
Organization Name:OPTICA PRISMA
Other - Org Name:OPTICA PRISMA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-918-1749
Mailing Address - Street 1:205 OESTE CALLE DE LA CANDELARIA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-918-1749
Mailing Address - Fax:
Practice Address - Street 1:PR 402 KM 2.9 BARRIO QUEBRADA LARGA
Practice Address - Street 2:VALLEY HILLS PROFESSIONAL CENTER SUITE 11
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-918-1749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty