| |
Avenida De Diego, 310 Plaza De Diego Local 102b, San Juan, PR 00909 | |
(787) 776-8570 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | Avenida De Diego, San Juan, Puerto Rico |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1881224673 | NPI | - | NPPES |
1578111043 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
162 Montague St Apt 2, Brooklyn, NY 11201-3506 Ph: (646) 512-0313 | Avenida De Diego, 310 Plaza De Diego Local 102b, San Juan, PR 00909 Ph: (787) 776-8570 |