Organization
KCM OPTICAL INC EYE CENTER BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OTHONIEL GARCIA SR. O (PRESIDENT)
(787) 344-6192
Entity
Organization
Contact information
Practice address
119 TRIGAL PLZ STE 4, MANATI, PR 00674-5518
(787) 884-5924
(787) 854-4407
Mailing address
600 CALLE TURIN, VEGA BAJA, PR 00693-3604
(787) 884-5924
(787) 854-4407
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
06222780019
PR
332H00000X
Eyewear Supplier
2015055550PUS076357
PR
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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