Provider Demographics
NPI:1912623471
Name:COROZAL VISION CARE, LLC
Entity type:Organization
Organization Name:COROZAL VISION CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CONTRATACIONES
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:NARVAEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-621-3700
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0634
Mailing Address - Country:US
Mailing Address - Phone:787-621-3700
Mailing Address - Fax:787-621-3762
Practice Address - Street 1:CARR #2 KM 156.5 OFFICE PARK I SUITE 206
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-621-3700
Practice Address - Fax:787-621-3762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COROZAL VISION CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-17
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty