Provider Demographics
NPI:1942013669
Name:EYEMART PR LLC
Entity type:Organization
Organization Name:EYEMART PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-674-7749
Mailing Address - Street 1:AVE.CONDADO # 64
Mailing Address - Street 2:PLAZA DEL CONDADO APT.904
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-674-7749
Mailing Address - Fax:
Practice Address - Street 1:CC36 CALLE CEIBAS
Practice Address - Street 2:ESTANCIAS DE RIO HONDO III
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty