Provider Demographics
NPI:1699070003
Name:B&J OPTICAL BOUTIQUE INC.
Entity type:Organization
Organization Name:B&J OPTICAL BOUTIQUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:787-674-4460
Mailing Address - Street 1:318 CALLE PARAGUAY
Mailing Address - Street 2:EL PRADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4029
Mailing Address - Country:US
Mailing Address - Phone:787-674-4460
Mailing Address - Fax:
Practice Address - Street 1:313 AVE BARBOSA
Practice Address - Street 2:ESQUINA CALLE PARAGUAY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3307
Practice Address - Country:US
Practice Address - Phone:787-674-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR416156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty