Provider Demographics
NPI:1588260988
Name:OPTIQUS VISION OUTLET, INC
Entity type:Organization
Organization Name:OPTIQUS VISION OUTLET, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOHEMIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-234-0920
Mailing Address - Street 1:1 CALLE ACUARELA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3590
Mailing Address - Country:US
Mailing Address - Phone:787-234-0920
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON SHOPPING CENTER SUITE 5
Practice Address - Street 2:CARRETERA 2 INTERSECCION 167
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-234-0920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier