Provider Demographics
NPI:1427673383
Name:SALINAS OPTICAL CLINIC CORPORATION
Entity type:Organization
Organization Name:SALINAS OPTICAL CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MUNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-509-3190
Mailing Address - Street 1:URB EL MADRIGAL
Mailing Address - Street 2:CALLE 3 E33
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-509-3190
Mailing Address - Fax:
Practice Address - Street 1:64 CALLE BALDORIOTY ESQ BARBOSA
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-509-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699217866OtherNPI