Organization
MAYAGUEZ OPTICAL LAB INC
Active
Other names
SEARS OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH L VAZQUEZ (PRESIDENT)
(787) 834-2492
Entity
Organization
Contact information
Practice address
CALLE PERAL #14 EDIFICIO LA PALMA, OFICINA 1A, MAYAGUEZ, PR 00680
(787) 834-2492
(787) 265-2190
Mailing address
14 CALLE PERAL EDIFICIO LA PALMA, 1A, MAYAGUEZ, PR 00680
(787) 834-2492
(787) 265-2190
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00083
VISION HEMISFERICA
PR
01
—
0945
INTERNATIONAL MEDICAL CAR
PR
01
—
1780722454
MEDICAL CARD SYSTEM
PR
01
—
1823-5
PROSSAM
PR
Enumeration date
02/02/2007
Last updated
05/15/2019
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