Provider Demographics
NPI:1699970640
Name:CONSULTORIO VISUAL
Entity type:Organization
Organization Name:CONSULTORIO VISUAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AURILISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-857-1807
Mailing Address - Street 1:2 CALLE B
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1911
Mailing Address - Country:US
Mailing Address - Phone:787-857-1807
Mailing Address - Fax:787-857-1807
Practice Address - Street 1:2 CALLE B
Practice Address - Street 2:SUITE 1
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1911
Practice Address - Country:US
Practice Address - Phone:787-857-1807
Practice Address - Fax:787-857-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier