Provider Demographics
NPI:1366748337
Name:NEW OPTICAL
Entity type:Organization
Organization Name:NEW OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-785-3374
Mailing Address - Street 1:243 CALLE RIO CIBUCO
Mailing Address - Street 2:URB.MONTE CASINO HEIGHTS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3761
Mailing Address - Country:US
Mailing Address - Phone:787-785-3374
Mailing Address - Fax:787-785-3374
Practice Address - Street 1:URB. SIERRA BAYAMON
Practice Address - Street 2:7-13 NORTH MAIN STE.1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4326
Practice Address - Country:US
Practice Address - Phone:787-785-3374
Practice Address - Fax:787-785-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
PR332H00000X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7132011OtherEYE SUPPLIERS