Organization
NEW OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA OTERO (OWNER)
(787) 785-3374
Entity
Organization
Contact information
Practice address
URB. SIERRA BAYAMON, 7-13 NORTH MAIN STE.1, BAYAMON, PR 00961-4326
(787) 785-3374
(787) 785-3374
Mailing address
243 CALLE RIO CIBUCO, URB.MONTE CASINO HEIGHTS, TOA ALTA, PR 00953-3761
(787) 785-3374
(787) 785-3374
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
332H00000X
PR
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7132011
EYE SUPPLIERS
PR
Enumeration date
02/08/2011
Last updated
02/08/2011
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