Provider Demographics
NPI:1528843059
Name:EYESTHETIC LLC
Entity type:Organization
Organization Name:EYESTHETIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALCOCER RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:939-642-0108
Mailing Address - Street 1:URB TERRALINDA
Mailing Address - Street 2:CALLE BARCELONA 21
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:939-642-0108
Mailing Address - Fax:
Practice Address - Street 1:PLAZA LAS PIEDRAS SHOPPING CENTER
Practice Address - Street 2:LOCAL G2
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:939-642-0108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty