Provider Demographics
NPI:1932597929
Name:BONES, MARY LUZ
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LUZ
Last Name:BONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OPTICA
Other - Middle Name:
Other - Last Name:LAFONT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:45 CALLE RUIZ BELVIS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3552
Mailing Address - Country:US
Mailing Address - Phone:787-743-5785
Mailing Address - Fax:787-743-5785
Practice Address - Street 1:45 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3552
Practice Address - Country:US
Practice Address - Phone:787-743-5785
Practice Address - Fax:787-743-5785
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
PR516156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty