Provider Demographics
NPI:1417795956
Name:VISION WORLD PLAZA GUAYNABO
Entity type:Organization
Organization Name:VISION WORLD PLAZA GUAYNABO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-353-4583
Mailing Address - Street 1:8 CALLE BENITO FEIJOO
Mailing Address - Street 2:URB VILLAS DEL ESTE
Mailing Address - City:SAN JUAN, PR
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6900
Mailing Address - Country:US
Mailing Address - Phone:939-353-4583
Mailing Address - Fax:787-731-5642
Practice Address - Street 1:AVE MARTINEZ NADAL LOT 22
Practice Address - Street 2:PLAZA GUAYNABO SHOP CTE
Practice Address - City:GUAYBABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:939-353-4583
Practice Address - Fax:939-353-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear Supplier