Provider Demographics
NPI:1588905038
Name:ESPEJUELOS ONLINE PR.
Entity type:Organization
Organization Name:ESPEJUELOS ONLINE PR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-529-8857
Mailing Address - Street 1:C-232 HH 15 COUNTRY CLUB
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-565-3756
Mailing Address - Fax:
Practice Address - Street 1:750 AVENIDE CAMPO RICO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-413-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTICA CENTRO VISUAL TUS OJOS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-08
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR401156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty