Organization
OPTICAL GALLERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAVIER OMAR VAZQUEZ (OPTICO)
(787) 293-0915
Entity
Organization
Contact information
Practice address
EXPRESSO TRUJILLO CARRT 181 KM 4.0, OPTICAL GALLERY ECONO MEGA 1, TRUJILLO ALTO, PR 00976
(787) 293-0915
Mailing address
URB SIERRA BAYAMON, CALLE 73 BLQ 85#5, BAYAMON, PR 00961
(787) 293-0915
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6-2002
—
PR
Enumeration date
12/06/2007
Last updated
12/06/2007
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