Provider Demographics
NPI:1760231609
Name:MIRAVISION
Entity type:Organization
Organization Name:MIRAVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAHIR
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-406-3562
Mailing Address - Street 1:109 CALLE REGENCIA
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9814
Mailing Address - Country:US
Mailing Address - Phone:787-824-1934
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE RAFAEL OCASIO
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3240
Practice Address - Country:US
Practice Address - Phone:787-824-1934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty