Provider Demographics
NPI:1487957585
Name:EYE CARE HOLDING OF PR, INC.
Entity type:Organization
Organization Name:EYE CARE HOLDING OF PR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-276-1969
Mailing Address - Street 1:401 BLVD MEDIA LUNA
Mailing Address - Street 2:#1202
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4954
Mailing Address - Country:US
Mailing Address - Phone:787-276-1969
Mailing Address - Fax:787-276-1969
Practice Address - Street 1:CAROLINA SHOPP CTR # 275
Practice Address - Street 2:AVE. FRAGOSO
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-276-1969
Practice Address - Fax:787-276-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty