Provider Demographics
NPI:1982948246
Name:FERNANDINI OPTICAL GALLERY, INC
Entity type:Organization
Organization Name:FERNANDINI OPTICAL GALLERY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-225-4021
Mailing Address - Street 1:COND MONTEMAR
Mailing Address - Street 2:1519 AVE LAS BRISAS STE 220
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-225-4021
Mailing Address - Fax:
Practice Address - Street 1:1519 AVE LAS BRISAS APT 220
Practice Address - Street 2:COND MONTEMAR
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-5241
Practice Address - Country:US
Practice Address - Phone:787-225-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier