Provider Demographics
NPI:1285101998
Name:EYEWEAR SHOP LLC
Entity type:Organization
Organization Name:EYEWEAR SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ORONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-630-3025
Mailing Address - Street 1:1652 CALLE SANTA AGUEDA APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4119
Mailing Address - Country:US
Mailing Address - Phone:787-630-3025
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA DEGETAU A18
Practice Address - Street 2:BONNEVILE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-630-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty